Wernli Karen J, Hampton John M, Trentham-Dietz Amy, Newcomb Polly A
Program in Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
Pharmacoepidemiol Drug Saf. 2009 Apr;18(4):284-90. doi: 10.1002/pds.1719.
Most epidemiologic studies have detected no association between prior use of antidepressant medications and breast cancer risk. Despite the uniform conclusion, there is a continuous rise in the proportion of women using antidepressants, lending support to further monitoring of disease effects.
We conducted a population-based case-control study among 2908 incident breast cancer cases diagnosed from 2003 to 2006, and 2927 control women from Wisconsin. Associations between antidepressant use and breast cancer risk were evaluated using multivariable logistic regression.
The association between use of antidepressant medications and breast cancer risk was null (OR = 0.89, 95%CI 0.78-1.01). When stratified by type of antidepressant, use of selective-serotonin reuptake inhibitors (SSRIs) resulted in a similar risk overall (OR = 0.85, 95%CI 0.72-1.00) and among former and currents users. There were no associations between other types of antidepressant classes and breast cancer risk. In assessing risks among the five most commonly used antidepressants, we detected no association with fluoxetine, sertraline, venlafaxine, or buproprion hydrochloride. There was a reduction in breast cancer risk of 36% (OR = 0.64, 95%CI 0.45-0.92) among users of paroxetine hydrochloride. When stratified by body mass index, there was a reduction in risk associated with antidepressant users who were not overweight (OR = 0.73, 95% CI 0.60-0.90), but this association was null in overweight women (p-interaction = 0.04).
Surveillance of health risks associated with antidepressant medications continues to be of public health importance, though these medications are not likely to be associated with breast cancer risk.
大多数流行病学研究未发现既往使用抗抑郁药物与乳腺癌风险之间存在关联。尽管结论一致，但使用抗抑郁药物的女性比例持续上升，这为进一步监测疾病影响提供了支持。
我们在2003年至2006年诊断出的2908例新发乳腺癌病例以及来自威斯康星州的2927名对照女性中开展了一项基于人群的病例对照研究。使用多变量逻辑回归评估抗抑郁药物使用与乳腺癌风险之间的关联。
抗抑郁药物使用与乳腺癌风险之间无关联（比值比[OR]=0.89，95%置信区间[CI]为0.78 - 1.01）。按抗抑郁药物类型分层时，使用选择性5-羟色胺再摄取抑制剂（SSRI）总体风险相似（OR = 0.85，95%CI为0.72 - 1.00），在既往使用者和当前使用者中也是如此。其他类型的抗抑郁药物类别与乳腺癌风险之间无关联。在评估五种最常用的抗抑郁药物的风险时，我们未发现与氟西汀、舍曲林、文拉法辛或盐酸安非他酮存在关联。使用盐酸帕罗西汀的人群中乳腺癌风险降低了36%（OR = 0.64，95%CI为0.45 - 0.92）。按体重指数分层时，非超重的抗抑郁药物使用者风险降低（OR = 0.73，95%CI为0.60 - 0.90），但超重女性中该关联不存在（交互作用p值 = 0.04）。
尽管这些药物不太可能与乳腺癌风险相关，但对与抗抑郁药物相关的健康风险进行监测仍具有公共卫生重要性。
