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 ISI (7)  • 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  • Bipolar Disorder  • Schizophrenia  • Pulmonary Diseases  • Pulmonary Diseases, Other  • 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.

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    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

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  

Secondary Effects of Antipsychotics: Women at Greater Risk Than Men
Seeman
Schizophr Bull 2008;0:sbn023v1-sbn023.
ABSTRACT | FULL TEXT  

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