|
There is some evidence that antidepressant (AD) use is associated with increased cancer risk, although the results from both epidemiological and pre-clinical studies have been mixed. Reviewing the evidence is a critical public health issue in light of the increasing prevalence of AD use, especially among women, and in light of the fact that 1 in 8 women will be diagnosed with cancer of the breast during their lifetime.
Ovarian cancer is the second most frequently occurring female reproductive cancer and causes more deaths than any other gynecological cancer.
In the US alone, over 27 million people are taking an AD, most of whom are women, for they are twice as likely as men to be diagnosed with Major Depressive Disorder and up to three times more likely to be diagnosed with Dysthymic Disorder.
ADs are increasingly being prescribed for other conditions such as hot flashes, headache, back pain, neuropathy, sleep-related conditions, anxiety spectrum disorders, eating disorders, and fibromyalgia.
Scientists searched English-language articles in MEDLINE, PsychINFO, the Science Citations Index and the Cochrane Central Register of Controlled Clinical Trials (through November 2010). A total of 61 articles that assessed the relationship between breast and ovarian cancer and AD use and articles that examined the effect of ADs on cell growth were included. Multi-modal screening techniques were used to investigate researchers' financial ties with industry. A random effects meta-analysis was used to pool the findings from the epidemiological literature.
Thirty-three percent (20/61) of the studies reported a positive association between ADs and cancer. Sixty-seven percent (41/61) of the studies reported no association or antiproliferative effect. The pooled odds ratio for the association between AD use and breast/ovarian cancer in the epidemiologic studies was 1.11 (95% CI, 1.03–1.20). Researchers with industry affiliations were significantly less likely than researchers without those ties to conclude that ADs increase the risk of breast or ovarian cancer. (0/15 [0%] vs 20/46 [43.5%] (Fisher's Exact test P = 0.0012.
Both the pre-clinical and clinical data are mixed in terms of showing an association between AD use and breast and ovarian cancer. The possibility that ADs may exhibit a bi-phasic effect, whereby short-term use and/or low dose antidepressants may increase the risk of breast and ovarian cancer, warrants further investigation.
Industry affiliations were significantly associated with negative conclusions regarding cancer risk. The findings have implications in light of the 2009 USPSTF guidelines for breast cancer screening and for the informed consent process.
Author Contributions and References
Lisa Cosgrove1,3*, Ling Shi2, David E. Creasey3,4, Maria Anaya-McKivergan5, Jessica A. Myers6, Krista F. Huybrechts6
1 The Edmond J. Safra Center for Ethics, Harvard University, Cambridge, Massachusetts, United States of America, 2 Department of Nursing and Health Sciences, University of Massachusetts, Boston, Massachusetts, United States of America, 3 Department of Counseling and School Psychology, University of Massachusetts, Boston, Massachusetts, United States of America, 4 Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America, 5 College of Social Sciences, University of Phoenix, Yuma, Arizona, United States of America, 6 Division of Pharmacoepiodemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
Source
Cosgrove L, Shi L, Creasey DE, Anaya-McKivergan M, Myers JA, et al. (2011) Antidepressants and Breast and Ovarian Cancer Risk: A Review of the Literature and Researchers' Financial Associations with Industry. PLoS ONE 6(4): e18210.
doi:10.1371/journal.pone.0018210
http://www.plosone.org/home.action
Funding: This study was funded in part by the non-profit cancer foundation “Men with Heart” by a grant awarded to Dr. Cosgrove. She also received two internal grants from the University of Massachusetts-Boston (a proposal development grant and the Endowed Faculty Career Development Award). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the
manuscript.
(MDN)
|
