Department of Public Health, Tzu-Chi University, No. 701, Chung Yang Road, Section 3, Hualien, 97004 Taiwan.
Schizophr Bull. 2013 Mar;39(2):407-16. doi: 10.1093/schbul/sbr162. Epub 2011 Nov 1.
Both genetic and environmental factors have been reasoned for cancer development in schizophrenia patients. However, the influence of age of onset and duration of schizophrenia on cancer incidence has rarely been emphasized. Besides, bipolar disorder tends to resemble schizophrenia from the perspective of multiple rare mutations. Comparing pattern and risk of cancers between schizophrenia and bipolar patients is illuminating.
This study used the Taiwan National Health Insurance Database. A total of 71,317 schizophrenia and 20,567 bipolar disorder patients from 1997 to 2009 were enrolled. Both cohorts were followed up for cancer during the same period by record linkage with the cancer certification in Taiwan. Age and gender standardized incidence ratios (SIRs) of overall and site-specific cancers were calculated.
The SIR for all cancers was 1.17 for the schizophrenia cohort. Increased cancer risk (SIR: 1.31, 95% CI: 1.17-1.48) was observed in females but not males. For the bipolar disorder cohort, the SIR for all cancers was 1.29, but the excess risk was found in males (SIR: 1.42, 95% CI: 1.14-1.77) and not females. Cancer risk decreases as the duration and age of onset of schizophrenia increases. If schizophrenia is diagnosed before 50, the SIRs for colorectal, breast, cervical, and uterine cancers increase but if diagnosed after 50, the SIRs for all cancers decrease except for breast cancer. In bipolar disorder, the SIRs for all site-specific cancers were insignificant.
Among schizophrenia patients, overall cancer risk varies inversely with age at diagnosis and disease duration. Besides, gender-specific cancer risks differ between schizophrenia and bipolar disorder.
遗传和环境因素都被认为与精神分裂症患者的癌症发展有关。然而，发病年龄和精神分裂症持续时间对癌症发病率的影响很少受到强调。此外，从多种罕见突变的角度来看，双相情感障碍往往与精神分裂症相似。比较精神分裂症和双相情感障碍患者的癌症模式和风险具有启发性。
本研究使用了台湾全民健康保险数据库。从 1997 年到 2009 年，共纳入了 71317 例精神分裂症患者和 20567 例双相情感障碍患者。通过与台湾癌症认证的记录链接，在同一时期对这两个队列进行了癌症随访。计算了总体和特定部位癌症的年龄和性别标准化发病率比（SIR）。
精神分裂症队列的所有癌症的 SIR 为 1.17。女性的癌症风险增加（SIR：1.31，95%CI：1.17-1.48），而男性则没有。对于双相情感障碍队列，所有癌症的 SIR 为 1.29，但在男性中发现了超额风险（SIR：1.42，95%CI：1.14-1.77），而女性则没有。随着精神分裂症的持续时间和发病年龄的增加，癌症风险会降低。如果精神分裂症在 50 岁之前被诊断出来，那么结直肠癌、乳腺癌、宫颈癌和子宫癌的 SIR 会增加，但如果在 50 岁之后被诊断出来，除了乳腺癌之外，所有癌症的 SIR 都会降低。在双相情感障碍中，所有特定部位癌症的 SIR 均无显著性差异。
在精神分裂症患者中，总体癌症风险与诊断时的年龄和疾病持续时间呈反比。此外，精神分裂症和双相情感障碍的性别特异性癌症风险不同。
