Bird Steven B
UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA 01545, USA.
Toxicol Rep. 2025 Feb 1;14:101927. doi: 10.1016/j.toxrep.2025.101927. eCollection 2025 Jun.
Antipsychotic drugs are effective at improving both the positive and negative symptoms of schizophrenia as well as the manic phase of bipolar disorder. Whether an antipsychotic is termed typical or atypical is related to the xenobiotic's propensity to cause extrapyramidal side effects. However, with a few exceptions, drugs of both classes of antipsychotics are known to cause hyperprolactinemia. As many breast cancers are responsive to prolactin concentrations, the persistent increase in prolactin of the antipsychotics has implications for public health and carcinogenesis. The objective of this study was to review the extant literature on hyperprolactinemia due to antipsychotics, and to determine the risk imposed by those drugs on human breast cancer. A summary risk of breast cancer with use of any antipsychotic was found to be 1.19 (95 % confidence interval 1.10-1.30). When limiting usage of antipsychotics to 5 or more years, the summary risk increased to 1.26 (95 % confidence interval 1.12-1.43). And when limited to those studies who evaluated only those medications with the greatest increase in prolactin, the risk increased to 1.59 (95 % confidence interval 1.37-1.85). Given this increased risk of breast cancer, stronger warnings about this increased risk are warranted, and regular monitoring of prolactin levels and breast cancer screening should be part of the management plan for these patients.
抗精神病药物在改善精神分裂症的阳性和阴性症状以及双相情感障碍的躁狂期方面均有效。一种抗精神病药物被称为典型或非典型与该外源性物质引起锥体外系副作用的倾向有关。然而，除了少数例外，已知这两类抗精神病药物都会导致高催乳素血症。由于许多乳腺癌对催乳素浓度有反应，抗精神病药物导致的催乳素持续升高对公众健康和致癌作用有影响。本研究的目的是回顾关于抗精神病药物所致高催乳素血症的现有文献，并确定这些药物对人类乳腺癌造成的风险。发现使用任何抗精神病药物患乳腺癌的汇总风险为1.19（95%置信区间1.10 - 1.30）。当将抗精神病药物的使用限制在5年或更长时间时，汇总风险增加到1.26（95%置信区间1.12 - 1.43）。而当仅限于那些仅评估催乳素升高幅度最大的药物的研究时，风险增加到1.59（95%置信区间1.37 - 1.85）。鉴于患乳腺癌的风险增加，有必要就这种风险增加发出更强有力的警告，并且定期监测催乳素水平和进行乳腺癌筛查应成为这些患者管理计划的一部分。
