Neuroleptic-induced Prolactin Level Elevation and Breast Cancer

Schyve, Paul M.; Smithline, Francine; Meltzer, Herbert Y.

doi:10.1001/archpsyc.1978.01770350017001

Cited by 97 publications

(12 citation statements)

References 92 publications

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“…Epidemiological studies have produced inconsistent findings (Overall, 1978;Schyve, 1978;Wagner & Mantel, 1978;Kanhouwa et al, 1984;Nakane et al, 1986;Gulbinat et al, 1992;Halbreich et al, 1996;Lichtermann et al, 2001), although a more recent cohort study reported a relative risk of 1.16 (95% CI, 1.07 -1.26) for breast cancer associated with use of neuroleptic medication, as well as a positive dose -response relationship (Wang et al, 2002). This study included information on a number of factors not included in previous studies, but residual confounding by factors such as reproductive history and family history of breast cancer or incomplete information on socioeconomic status and exogenous hormone use cannot be ruled out (Wang et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, concern has been raised that neuroleptic medication may increase breast cancer risk due to their prolactinincreasing effect (Schyve et al, 1978) and this has been reported among women with schizophrenia (Nakane and Ohta, 1986;Gulbinat et al, 1992;Lichtermann et al, 2001) and a range of psychiatric disorders (Halbreich et al, 1996;Wang et al, 2002). The few studies of breast cancer risk in patients treated with neuroleptics have mainly found no excess (Overall, 1978;Wagner and Mantel, 1978;Kanhouwa et al, 1984;Kelly et al, 1999), an exception being a recent cohort study (Wang et al, 2002).…”

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confidence: 99%

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Cancer risk among users of neuroleptic medication: a population-based cohort study

et al. 2006

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It has been suggested that neuroleptic medication may decrease cancer risk. We compared cancer risks in a population-based cohort study of 25 264 users (X2 prescriptions) of neuroleptic medications in the county of North Jutland, Denmark, during 1989Denmark, during -2002, with that of county residents who did not receive such prescriptions. Statistical analyses were based on age-standardisation and Poisson regression analysis, adjusting for age, calendar period, COPD, liver cirrhosis or alcoholism, use of NSAID, and, for breast cancer, additionally for use of hormone therapy, age at first birth, and number of children. Use of neuroleptic medications was associated with a decreased risk for rectal cancer in both women and men (adjusted IRRs of 0.61 (95% confidence interval, 0.41 -0.91) and 0.82 (0.56 -1.19), respectively) and for colon cancer in female users (0.78; 0.62 -0.98). Some risk reduction was seen for prostate cancer (0.87; 0.69 -1.08), but breast cancer risk was close to unity (0.93; 0.74 -1.17). Overall, treatment with neuroleptic medications was not related to a reduced risk of cancer, but for cancers of the rectum, colon and prostate there were suggestive decreases in risk.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Cancer risk among users of neuroleptic medication: a population-based cohort study

et al. 2006

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“…Table 3 presents the conditions in which elevated PRL values and/or HPRL can arise [5, 15, 17, 23, 29, 57, 115, 157–159]. …”

Section: Causes Of Elevated Prl Values and Hprlmentioning

confidence: 99%

The Effects of Novel and Newly Approved Antipsychotics on Serum Prolactin Levels: A Comprehensive Review

et al. 2014

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Since the 1970s, clinicians have increasingly become more familiar with hyperprolactinemia (HPRL) as a common adverse effect of antipsychotic medication, which remains the cornerstone of pharmacological treatment for patients with schizophrenia. Although treatment with second-generation antipsychotics (SGAs) as a group is, compared with use of the first-generation antipsychotics, associated with lower prolactin (PRL) plasma levels, the detailed effects on plasma PRL levels for each of these compounds in reports often remain incomplete or inaccurate. Moreover, at this moment, no review has been published about the effect of the newly approved antipsychotics asenapine, iloperidone and lurasidone on PRL levels. The objective of this review is to describe PRL physiology; PRL measurement; diagnosis, causes, consequences and mechanisms of HPRL; incidence figures of (new-onset) HPRL with SGAs and newly approved antipsychotics in adolescent and adult patients; and revisit lingering questions regarding this hormone. A literature search, using the MEDLINE database (1966–December 2013), was conducted to identify relevant publications to report on the state of the art of HPRL and to summarize the available evidence with respect to the propensity of the SGAs and the newly approved antipsychotics to elevate PRL levels. Our review shows that although HPRL usually is defined as a sustained level of PRL above the laboratory upper limit of normal, limit values show some degree of variability in clinical reports, making the interpretation and comparison of data across studies difficult. Moreover, many reports do not provide much or any data detailing the measurement of PRL. Although the highest rates of HPRL are consistently reported in association with amisulpride, risperidone and paliperidone, while aripiprazole and quetiapine have the most favorable profile with respect to this outcome, all SGAs can induce PRL elevations, especially at the beginning of treatment, and have the potential to cause new-onset HPRL. Considering the PRL-elevating propensity of the newly approved antipsychotics, evidence seems to indicate these agents have a PRL profile comparable to that of clozapine (asenapine and iloperidone), ziprasidone and olanzapine (lurasidone). PRL elevations with antipsychotic medication generally are dose dependant. However, antipsychotics having a high potential for PRL elevation (amisulpride, risperidone and paliperidone) can have a profound impact on PRL levels even at relatively low doses, while PRL levels with antipsychotics having a minimal effect on PRL, in most cases, can remain unchanged (quetiapine) or reduce (aripiprazole) over all dosages. Although tolerance and decreases in PRL values after long-term administration of PRL-elevating antipsychotics can occur, the elevations, in most cases, remain above the upper limit of normal. PRL profiles of antipsychotics in children and adolescents seem to be the same as in adults. The hyperprolactinemic effects of antipsychotic medication are mostly correlated with their affi...

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“…Neuro leptics, however, do not increase the incidence of breast cancer in patients who receive long-term treatment with these drugs. 13 Elevated prolactin levels can also contrib ute to menstrual irregularities and sexual dysfunction. Changing the regimen to a lower potency dopamine D-2 antagonist may produce a lower level of hyperprolactinemia, which may cause these side effects to subside.…”

Section: Drug Selectionmentioning

confidence: 99%

Antipsychotic Agents: A Clinical Update

Black¹,

Richelson²,

Richardson³

1985

Mayo Clinic Proceedings

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Antipsychotic agents have many indications and are frequently used. All physicians, regardless of their subspecialty, will most likely treat patients who receive these drugs. This article is designed to help nonpsychiatric physicians use antipsychotics appropriately. The indications, recommended dosages, side effects, and drug interactions of antipsychotic medications are reviewed. Receptor binding data are used to help predict the side-effect profile of these agents. Knowledge of these side effects and of the patient's medical condition helps the physician select a drug that the patient can tolerate. Management of overdose situations is discussed.

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Neuroleptic-induced Prolactin Level Elevation and Breast Cancer

Cited by 97 publications

References 92 publications

Cancer risk among users of neuroleptic medication: a population-based cohort study

Cancer risk among users of neuroleptic medication: a population-based cohort study

The Effects of Novel and Newly Approved Antipsychotics on Serum Prolactin Levels: A Comprehensive Review

Antipsychotic Agents: A Clinical Update

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