• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (37)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Men's Health  • Prostate Disease  • Oncology  • Breast Cancer  • Colon Cancer  • Lung Cancer  • Prostate Cancer  • Psychiatry  • Bipolar Disorder  • Schizophrenia  • Pulmonary Diseases  • Pulmonary Diseases, Other  • Gastroenterology  • Gastrointestinal Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Nested Case-Control Study

Julia Hippisley-Cox, MD; Yana Vinogradova, MSc; Carol Coupland, PhD; Chris Parker, MSc

Arch Gen Psychiatry. 2007;64(12):1368-1376. doi:10.1001/archpsyc.64.12.1368

Context  There is conflicting evidence on whether people with schizophrenia have a different risk of cancer from that of the general population.

Objective  To determine the risk of 6 common cancers in patients with schizophrenia or bipolar disorder.

Design  Population-based, nested, case-control study.

Setting  A total of 454 practices contributing to the QRESEARCH general practice database.

Participants  We analyzed 40 441 incident cases of 6 cancers (breast, colon, rectal, gastroesophageal, prostate, and respiratory) and up to 5 controls per case matched by single year of age, sex, general practice, and calendar time.

Main Outcome Measures  Odds ratios (ORs) for cancer risk associated with schizophrenia and bipolar disorder, adjusting for smoking, body mass index, socioeconomic status, comorbidities, and prescribed medications, including antipsychotics.

Results  For breast cancer, we identified 10 535/50 074 cases/controls; colon cancer, 5108/24 458; rectal cancer, 3248/15 552; gastroesophageal cancer, 3854/18 477; prostate cancer, 10 190/48 748; and respiratory cancer, 7506/35 981. After adjustment, patients with schizophrenia had a 190% increased colon cancer risk (adjusted OR, 2.90; 95% confidence interval [CI], 1.85-4.57), a marginal increased breast cancer risk (adjusted OR, 1.52; 95% CI, 1.10-2.11), and a 47% decreased respiratory cancer risk (adjusted OR, 0.53, 95% CI, 0.34-0.85). Patients with schizophrenia taking antipsychotics had a 308% increased colon cancer risk (adjusted OR, 4.08; 95% CI, 2.43-6.84). Patients with bipolar disorder had cancer risks similar to patients with neither condition after adjustment.

Conclusions  Patients with schizophrenia have a significantly higher risk of colon cancer and a lower risk of respiratory cancer compared with patients without schizophrenia after adjustment for confounders. In contrast, the risks of cancer in patients with and without bipolar disorder are similar, suggesting that residual confounding is unlikely to explain the findings. The increased risk of colon cancer is particularly marked in patients with schizophrenia who take antipsychotic medications.

Author Affiliations: Division of Primary Care, University of Nottingham (Drs Hippisley-Cox and Coupland and Ms Vinogradova), and Nottingham Primary Care Research Partnership (Ms Parker), Nottingham, England.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cancer Incidence in Patients With Schizophrenia or Bipolar Disorder: A Nationwide Population-Based Study in Taiwan, 1997-2009
Lin et al.
Schizophr Bull 2011;0:sbr162v1-sbr162.
ABSTRACT | FULL TEXT  

Assertive Community Treatment and the Physical Health Needs of Persons With Severe Mental Illness: Issues Around Integration of Mental Health and Physical Health
Shattell et al.
J Am Psychiatr Nurses Assoc 2011;17:57-63.
ABSTRACT  

Review: Mortality in schizophrenia: a measurable clinical endpoint
Bushe et al.
J Psychopharmacol 2010;24:17-25.
ABSTRACT  

Review: Cancer and schizophrenia: is there a paradox?
Hodgson et al.
J Psychopharmacol 2010;24:51-60.
ABSTRACT  

Effects of severe mental illness on survival of people with diabetes
Vinogradova et al.
Br. J. Psychiatry 2010;197:272-277.
ABSTRACT | FULL TEXT  

A review of hyperprolactinaemia and severe mental illness: Are there implications for clinical biochemistry?
Bushe et al.
Ann Clin Biochem 2010;47:292-300.
ABSTRACT | FULL TEXT  

Schizophrenia: Women Bear a Disproportionate Toll of Antipsychotic Side Effects
Seeman
J Am Psychiatr Nurses Assoc 2010;16:21-29.
ABSTRACT  

Secondary Effects of Antipsychotics: Women at Greater Risk Than Men
Seeman
Schizophr Bull 2009;35:937-948.
ABSTRACT | FULL TEXT  

Involvement of SMARCA2/BRM in the SWI/SNF chromatin-remodeling complex in schizophrenia
Koga et al.
Hum Mol Genet 2009;18:2483-2494.
ABSTRACT | FULL TEXT  

Mortality and tardive dyskinesia: long-term study using the US National Death Index
Dean and Thuras
Br. J. Psychiatry 2009;194:360-364.
ABSTRACT | FULL TEXT  

Cancer Risk and Schizophrenia
JWatch Psychiatry 2008;2008:4-4.
FULL TEXT