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Breast cancer recurrence in relation to antidepressant use

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Abstract

Purpose

Women with breast cancer frequently use antidepressants; however, questions about the effect of these medications on breast cancer recurrence remain.

Methods

We identified 4,216 women ≥18 years with an incident stage I or II breast cancer diagnosed between 1990 and 2008 in a mixed-model healthcare delivery system linked to a cancer registry. Recurrences were ascertained from chart review. Medication exposures were extracted from electronic pharmacy records. We used multivariable Cox proportional hazards models to estimate hazard ratios (HR) and 95 % confidence intervals (CI) to assess the association between antidepressant use and breast cancer recurrence and mortality. We also conducted analyses restricted to tamoxifen users.

Results

Antidepressants overall, tricyclic antidepressants, and selective serotonin reuptake inhibitors were not associated with risk of breast cancer recurrence or mortality. Women taking paroxetine only (adjusted HR: 1.66; 95 % CI 1.02, 2.71) and trazodone only (adjusted HR: 1.76; 95 % CI 1.06, 2.92), but not fluoxetine only (adjusted HR: 0.92; 95 % CI 0.55, 1.53), had higher recurrence risks than antidepressant nonusers. There was some suggestion of an increased recurrence risk with concurrent paroxetine and tamoxifen use compared with users of tamoxifen only (adjusted HR: 1.49; 95 % CI 0.79, 2.83).

Conclusions

In general, antidepressants did not appear increase risk of breast cancer recurrence, though there were some suggested increases in risk that warrant further investigation in other datasets. Our results combined systematically and quantitatively with results from other studies may be useful for patients and providers making decisions about antidepressant use after breast cancer diagnosis.

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Acknowledgments

The authors would like to thank Dr. Heidi Wirtz for helpful discussions and input on preliminary analyses.

Funding

This study was funded by the National Cancer Institute at the National Institutes of Health, Award Number R01CA120562 to Denise M. Boudreau. Part of the data collection was supported by a grant from the National Cancer Institute: U01CA63731, PI: Buist. The collection of cancer incidence data used in this study was supported by the Cancer Surveillance System of the Fred Hutchinson Cancer Research Center, which is funded by Contract No. N01-CN-67009 and N01-PC-35142 from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute with additional support from the Fred Hutchinson Cancer Research Center and the State of Washington. Funders did not participate in the design, data collection, manuscript drafting, or decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA

    Jessica Chubak, Erin J. A. Bowles, Onchee Yu, Diana S. M. Buist, Monica Fujii & Denise M. Boudreau

  2. Department of Epidemiology, University of Washington, Box 357236, Seattle, WA, 98195, USA

    Jessica Chubak & Diana S. M. Buist

  3. Department of Health Services, University of Washington, Box 357660, Seattle, WA, 98195-7660, USA

    Diana S. M. Buist

  4. Department of Pharmacy, University of Washington, Box 357631, Seattle, WA, 98195-7631, USA

    Denise M. Boudreau

Authors
  1. Jessica Chubak
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  2. Erin J. A. Bowles
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  3. Onchee Yu
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  4. Diana S. M. Buist
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  5. Monica Fujii
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  6. Denise M. Boudreau
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Corresponding author

Correspondence to Jessica Chubak.

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Conflict of interest

Ms. Yu has received funding from unrelated research grants awarded to Group Health Research Institute from Amgen and Bayer. Dr. Boudreau has received funding from unrelated research grants awarded to Group Health Research Institute from Amgen, Sanofi Aventis, and Johnson & Johnson.

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Chubak, J., Bowles, E.J.A., Yu, O. et al. Breast cancer recurrence in relation to antidepressant use. Cancer Causes Control 27, 125–136 (2016). https://doi.org/10.1007/s10552-015-0689-y

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