Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-23T09:07:17.216Z Has data issue: false hasContentIssue false
  • English
  • Français

Cancer incidence in young and middle-aged people with schizophrenia: nationwide cohort study in Taiwan, 2000–2010

Published online by Cambridge University Press:  21 November 2016

L. Y. Chen ,
Y. N. Hung ,
Y. Y. Chen ,
S. Y. Yang ,
C. H. Pan ,
C. C. Chen  and
C. J. Kuo
L. Y. Chen
Affiliation:
Taipei City Psychiatric Center, Songde Branch, Taipei City Hospital, Taipei, Taiwan Department of Psychiatry, National Cheng Kung University, Tainan, Taiwan
Y. N. Hung
Affiliation:
School of Gerontology Health Management and Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Tainan, Taiwan
Y. Y. Chen
Affiliation:
Taipei City Psychiatric Center, Songde Branch, Taipei City Hospital, Taipei, Taiwan Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan
S. Y. Yang
Affiliation:
Taipei City Psychiatric Center, Songde Branch, Taipei City Hospital, Taipei, Taiwan Graduate Institute of Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
C. H. Pan
Affiliation:
Taipei City Psychiatric Center, Songde Branch, Taipei City Hospital, Taipei, Taiwan
C. C. Chen
Affiliation:
Department of Psychiatry, School of Medicine, Taipei Medical University and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
C. J. Kuo*
Affiliation:
Taipei City Psychiatric Center, Songde Branch, Taipei City Hospital, Taipei, Taiwan Department of Psychiatry, School of Medicine, Taipei Medical University and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
*
*Address for correspondence: C. J. Kuo, MD, Ph.D., Department of General Psychiatry, Taipei City Psychiatric Center, 309 Sung-Te Road, Taipei 110, Taiwan. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

For nearly a century, the incidence of cancer in people with schizophrenia was lower than in the general population. In the recent decade, the relationship between cancer and schizophrenia has become obscured. Thus, we investigated the cancer risk among young and middle-aged patients with schizophrenia.

Methods.

Records of newly admitted patients with schizophrenia (n = 32 731) from January 2000 through December 2008 were retrieved from the Psychiatric Inpatient Medical Claims database in Taiwan, and the first psychiatric admission of each patient during the same period was defined as the baseline. We obtained 514 incident cancer cases that were monitored until December 2010. Standardised incidence ratios (SIRs) were calculated to compare the risk of cancer between those with schizophrenia and the general population. Stratified analyses of cancer incidences were performed by gender, site of cancers and duration since baseline (first psychiatric admission).

Results.

The incidence of cancer for all sites was slightly higher than that of the general population for the period (SIR = 1.15 [95% CI 1.06–1.26], p = 0.001). Men had a significantly higher incidence of colorectal cancer (SIR = 1.48 [95% CI 1.06–2.06], p = 0.019). Women had a higher incidence of breast cancer (SIR = 1.47 [95% CI 1.22–1.78], p < 0.001). Intriguingly, the risk for colorectal cancer was more pronounced 5 years after the first psychiatric admission rather than earlier (SIR = 1.94 [1.36–2.75], p < 0.001) and so was the risk for breast cancer (SIR = 1.85 [1.38–2.48], p < 0.001). The cancer incidence was higher in patients with schizophrenia contradicting the belief that schizophrenia was protective of cancers.

Conclusions.

Our analyses suggest that men and women with schizophrenia were more vulnerable to certain types of cancers, which indicates the need for gender-specific cancer screening programs. The fact that risk of colorectal cancer was more pronounced 5 years after the first psychiatric admission could imply the impact of unhealthy lifestyles or the possibility of delayed diagnoses.

Keywords

Breast cancercancercolorectal cancerschizophreniastandardised incidence ratio (SIR)
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 27 , Issue 2 , April 2018 , pp. 146 - 156
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abel, KM, Allin, MP, Jirtle, RL (2006). Schizophrenia, cancer and imprinting: early nutritional influences. British Journal of Psychiatry 188, 394.Google Scholar
Ahmed, RL, Schmitz, KH, Anderson, KE, Rosamond, WD, Folsom, AR (2006). The metabolic syndrome and risk of incident colorectal cancer. Cancer 107, 28–36.Google Scholar
Baan, R, Straif, K, Grosse, Y, Secretan, B, El Ghissassi, F, Bouvard, V, Altieri, A, Cogliano, V (2007). Carcinogenicity of alcoholic beverages. Lancet Oncology 8, 292–293.Google Scholar
Barak, Y, Achiron, A, Mandel, M, Mirecki, I, Aizenberg, D (2005). Reduced cancer incidence among patients with schizophrenia. Cancer 104, 2817–2821.Google Scholar
Basu, S, Dasgupta, PS (2000). Role of dopamine in malignant tumor growth. Endocrine 12, 237–241.Google Scholar
Bushe, CJ, Bradley, AJ, Wildgust, HJ, Hodgson, RE (2009). Schizophrenia and breast cancer incidence: a systematic review of clinical studies. Schizophrenia Research 114, 6–16.Google Scholar
Capasso, RM, Lineberry, TW, Bostwick, JM, Decker, PA, St Sauver, J (2008). Mortality in schizophrenia and schizoaffective disorder: an Olmsted County, Minnesota cohort: 1950–2005. Schizophrenia Research 98, 287–294.Google Scholar
Catts, VS, Catts, SV (2000). Apoptosis and schizophrenia: is the tumour suppressor gene, p53, a candidate susceptibility gene? Schizophrenia Research 41, 405–415.Google Scholar
Catts, VS, Catts, SV, O'Toole, BI, Frost, AD (2008). Cancer incidence in patients with schizophrenia and their first-degree relatives – a meta-analysis. Acta Psychiatrica Scandinavica 117, 323–336.Google Scholar
Chou, FH, Tsai, KY, Wu, HC, Shen, SP (2016). Cancer in patients with schizophrenia: what is the next step? Psychiatry and Clinical Neurosciences doi: 10.1111/pcn.12420.Google Scholar
Dai, Z, Xu, YC, Niu, L (2007). Obesity and colorectal cancer risk: a meta-analysis of cohort studies. World Journal of Gastroenterology 13, 4199–4206.Google Scholar
De Hert, M, Dekker, JM, Wood, D, Kahl, KG, Holt, RI, Moller, HJ (2009). Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). European Psychiatry 24, 412–424.Google Scholar
de Leon, J, Diaz, FJ (2005). A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophrenia Research 76, 135–157.Google Scholar
Drake, RE, Osher, FC, Noordsy, DL, Hurlbut, SC, Teague, GB, Beaudett, MS (1990). Diagnosis of alcohol use disorders in schizophrenia. Schizophrenia Bulletin 16, 57–67.Google Scholar
Esposito, K, Chiodini, P, Colao, A, Lenzi, A, Giugliano, D (2012). Metabolic syndrome and risk of cancer: a systematic review and meta-analysis. Diabetes Care 35, 2402–2411.Google Scholar
Gal, G, Goral, A, Murad, H, Gross, R, Pugachova, I, Barchana, M, Kohn, R, Levav, I (2012). Cancer in parents of persons with schizophrenia: is there a genetic protection? Schizophrenia Research 139, 189–193.Google Scholar
Goldacre, MJ, Kurina, LM, Wotton, CJ, Yeates, D, Seagroat, V (2005). Schizophrenia and cancer: an epidemiological study. British Journal of Psychiatry 187, 334–338.Google Scholar
Grinshpoon, A, Barchana, M, Ponizovsky, A, Lipshitz, I, Nahon, D, Tal, O, Weizman, A, Levav, I (2005). Cancer in schizophrenia: is the risk higher or lower? Schizophrenia Research 73, 333–341.Google Scholar
Haut, ER, Pronovost, PJ (2011). Surveillance bias in outcomes reporting. JAMA 305, 2462–2463.Google Scholar
Hippisley-Cox, J, Vinogradova, Y, Coupland, C, Parker, C (2007). Risk of malignancy in patients with schizophrenia or bipolar disorder: nested case-control study. Archives of General Psychiatry 64, 1368–1376.Google Scholar
Hodgson, R, Wildgust, HJ, Bushe, CJ (2010). Cancer and schizophrenia: is there a paradox? Journal of Psychopharmacology 24, 51–60.Google Scholar
Hung, YN, Yang, SY, Huang, MC, Lung, FW, Lin, SK, Chen, KY, Kuo, CJ, Chen, YY (2014). Cancer incidence in people with affective disorder: nationwide cohort study in Taiwan, 1997–2010. British Journal of Psychiatry 205, 183–188.Google Scholar
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2004). Tobacco smoke and involuntary smoking. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans 83, 1–1438.Google Scholar
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2010). Alcohol consumption and ethyl carbamate. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans 96, 3–1383.Google Scholar
Ji, J, Sundquist, K, Ning, Y, Kendler, KS, Sundquist, J, Chen, X (2013). Incidence of cancer in patients with schizophrenia and their first-degree relatives: a population-based study in Sweden. Schizophrenia Bulletin 39, 527–536.Google Scholar
Johnstone, EC, Owens, DG, Bydder, GM, Colter, N, Crow, TJ, Frith, CD (1989). The spectrum of structural brain changes in schizophrenia: age of onset as a predictor of cognitive and clinical impairments and their cerebral correlates. Psychological Medicine 19, 91–103.Google Scholar
Kisely, S, Forsyth, S, Lawrence, D (2016). Why do psychiatric patients have higher cancer mortality rates when cancer incidence is the same or lower? Australian and New Zealand Journal of Psychiatry 50, 254–263.Google Scholar
Lichtermann, D, Ekelund, J, Pukkala, E, Tanskanen, A, Lonnqvist, J (2001). Incidence of cancer among persons with schizophrenia and their relatives. Archives of General Psychiatry 58, 573–578.Google Scholar
Lin, GM, Chen, YJ, Kuo, DJ, Jaiteh, LE, Wu, YC, Lo, TS, Li, YH (2013). Cancer incidence in patients with schizophrenia or bipolar disorder: a nationwide population-based study in Taiwan, 1997–2009. Schizophrenia Bulletin 39, 407–416.Google Scholar
McGinty, EE, Zhang, Y, Guallar, E, Ford, DE, Steinwachs, D, Dixon, LB, Keating, NL, Daumit, GL (2012). Cancer incidence in a sample of Maryland residents with serious mental illness. Psychiatric Services 63, 714–717.Google Scholar
Monteleone, P, Martiadis, V, Maj, M (2009). Management of schizophrenia with obesity, metabolic, and endocrinological disorders. Psychiatric Clinics of North America 32, 775–794.Google Scholar
Mortensen, PB (1989). The incidence of cancer in schizophrenic patients. Journal of Epidemiology and Community Health 43, 43–47.Google Scholar
Mortensen, PB (1994). The occurrence of cancer in first admitted schizophrenic patients. Schizophrenia Research 12, 185–194.Google Scholar
Muir-Cochrane, E (2006). Medical co-morbidity risk factors and barriers to care for people with schizophrenia. Journal of Psychiatric and Mental Health Nursing 13, 447–452.Google Scholar
Newcomer, JW, Sernyak, MJ (2007). Identifying metabolic risks with antipsychotics and monitoring and management strategies. Journal of Clinical Psychiatry 68, e17.Google Scholar
Nielsen, RE, Uggerby, AS, Jensen, SO, McGrath, JJ (2013). Increasing mortality gap for patients diagnosed with schizophrenia over the last three decades – a Danish nationwide study from 1980 to 2010. Schizophrenia Research 146, 22–27.Google Scholar
Ochoa, S, Usall, J, Cobo, J, Labad, X, Kulkarni, J (2012). Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review. Schizophrenia Research and Treatment 2012, 916198. doi: 10.1155/2012/916198.Google Scholar
Rothman, KJ, Greeland, S (1998). Modern Epidemiology, 2nd edn. Lippincott Williams & Wilkins: Philadelphia, PA.Google Scholar
Sagud, M, Mihaljevic-Peles, A, Muck-Seler, D, Pivac, N, Vuksan-Cusa, B, Brataljenovic, T, Jakovljevic, M (2009). Smoking and schizophrenia. Psychiatria Danubina 21, 371–375.Google Scholar
Sicras-Mainar, A, Navarro-Artieda, R, Rejas-Gutierrez, J, Blanca-Tamayo, M (2008). Relationship between obesity and antipsychotic drug use in the adult population: a longitudinal, retrospective claim database study in Primary Care settings. Neuropsychiatric Disease and Treatment 4, 219–226.Google Scholar
Tran, E, Rouillon, F, Loze, JY, Casadebaig, F, Philippe, A, Vitry, F, Limosin, F (2009). Cancer mortality in patients with schizophrenia: an 11-year prospective cohort study. Cancer 115, 3555–3562.Google Scholar
Tworoger, SS, Eliassen, AH, Sluss, P, Hankinson, SE (2007). A prospective study of plasma prolactin concentrations and risk of premenopausal and postmenopausal breast cancer. Journal of Clinical Oncology 25, 1482–1488.Google Scholar
Wildgust, HJ, Hodgson, R, Beary, M (2010). The paradox of premature mortality in schizophrenia: new research questions. Journal of Psychopharmacology 24, 9–15.Google Scholar
Yamazawa, K, Matsui, H, Seki, K, Sekiya, S (2003). A case-control study of endometrial cancer after antipsychotics exposure in premenopausal women. Oncology 64, 116–123.Google Scholar
Yovel, G, Sirota, P, Mazeh, D, Shakhar, G, Rosenne, E, Ben-Eliyahu, S (2000). Higher natural killer cell activity in schizophrenic patients: the impact of serum factors, medication, and smoking. Brain, Behavior, and Immunity 14, 153–169.Google Scholar