Depression, Antidepressant Use, and Breast Cancer Risk

抑郁症、抗抑郁药的使用和乳腺癌风险

• 批准号: 8704461
• 负责人: Katherine Whitney Reeves
• 金额: $ 9.18万
• 依托单位: UNIVERSITY OF MASSACHUSETTS AMHERST
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-03 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8704461
• 关键词: Address; Adult; Affect; Anti-Inflammatory Agents; Anti-inflammatory; Antidepressive Agents; Area; Attenuated; Benefits and Risks; Breast Cancer Risk Factor; Breast Carcinogenesis; Cohort Studies; Complex; Data; Depressed mood; Foundations; General Population; High Risk Woman; Hormone Receptor; Immune system; Inflammation; Joints; Link; Literature; Measurement; Mental Depression; Nurses' Health Study; Obesity; Participant; Patients; Population; Postmenopause; Premenopause; Prolactin; Prospective Studies; Public Health; Recording of previous events; Reporting; Research; Resources; Risk; Sampling; Selective Serotonin Reuptake Inhibitor; Time; Weighing patient; Woman; cancer risk; cost; experience; follow-up; knowledge base; malignant breast neoplasm; middle age; population based; prospective; public health relevance

DESCRIPTION (provided by applicant): Depression has been hypothesized to increase breast cancer risk, with a few prospective studies with e10 years of follow-up suggesting a 2-4 times increased breast cancer risk among women with depression. Antidepressants (ADs) might mitigate hypothesized influences of depression on breast cancer risk through anti-inflammatory effects or may increase breast cancer risk through increasing circulating prolactin, especially for selective serotonin reuptake inhibitors (SSRIs). However, the proportion of SSRI users in the general population who will experience increased prolactin is unknown, and literature relating ADs to breast cancer risk provide inconsistent results. Surprisingly, previous studies have not jointly considered depression and AD use; prior studies of depression on breast cancer risk have not controlled for AD use, and vice versa. Additionally, the possibility that any increased risk associated with AD use might be due to the depression for which the AD is prescribed rather than the AD itself has not been fully explored. Additional questions regarding the impact of duration of each of these factors on breast cancer risk also remain. As a result, the relationships between depression, AD use and breast carcinogenesis remain poorly understood. Clarifying both the independent and joint effects of these exposures will provide critical information for the millions of women who are depressed and/or use ADs. We propose a prospective cohort study using data from the Nurses' Health Study (NHS) and NHS2 with the objective of investigating the complex associations potentially linking depression, AD use, and prolactin to breast cancer risk. Data on depression and AD use, as well as a range of known breast cancer risk factors, are available from 93,696 women (with 3,952 incident breast cancers) in NHS starting in 2000 and from 103,825 women in NHS2 (with 3,571 incident breast cancers) starting in 1993. Additionally, a subset of NHS and NHS2 participants (N=3,575 in NHS and N=1,549 in NHS2) have at least one prolactin measurement available for analysis. This unique resource will afford us excellent statistical power and substantial efficiencies in cos and time to address the following Specific Aims: 1. To evaluate whether depression increases risk of incident breast cancer independent of AD use; 2. To assess the effects of AD use on incident breast cancer risk; and 3. To determine the effects of AD use on circulating prolactin levels. This will be the first study to comprehensively evaluate the relationships between depression, AD use and breast cancer and to examine the effects of ADs on circulating prolactin levels in a large, population-based sample. This research will provide vital new information for clinicians and patients considering the risks and benefits of treatment for depression. Our results can fill key gaps in the knowledge base while providing the foundation for further study (e.g. relating changes in prolactin levels resulting from SSRI use to incident breast cancer).

描述（由申请人提供）：抑郁症已被假设以增加乳腺癌的风险，进行了一些前瞻性研究，E10年的随访表明抑郁症女性的乳腺癌风险增加了2-4倍。抗抑郁药（AD）可能会通过抗炎作用来减轻抑郁症对乳腺癌风险的假设影响，或者通过增加催乳素的循环蛋白，尤其是针对乳腺癌的风险 选择性5-羟色胺再摄取抑制剂（SSRIS）。但是，普通人群中SSRI使用者的比例尚不清楚催乳素，而将广告与乳腺癌风险有关的文献提供了不一致的结果。令人惊讶的是，以前的研究尚未共同考虑抑郁和AD的使用。先前对乳腺癌风险抑郁症的研究尚未控制AD使用，反之亦然。此外，与使用广告相关的任何风险增加的可能性可能是由于规定了广告而不是广告本身的抑郁症。关于这些因素持续时间对乳腺癌风险的影响的其他问题也仍然存在。结果，抑郁，AD使用和乳腺癌作用之间的关系知之甚少。阐明这些暴露的独立和共同影响将为数百万沮丧和/或使用广告的妇女提供关键信息。我们提出了一项使用护士健康研究（NHS）和NHS2的数据的前瞻性队列研究，目的是研究复杂的关联，可能将抑郁症，AD使用和催乳素与乳腺癌风险联系起来。从2000年开始，NHS的93,696名妇女（有3,952例事件乳腺癌）获得有关抑郁和广告使用的数据以及一系列已知的乳腺癌危险因素，从1993年开始，NHS2（有3,571名事件乳腺癌），从1​​993年开始NHS2（有3,571例乳腺癌）。 NHS2中的n = 1,549）至少有一个可用于分析的催乳素测量。这种独特的资源将为我们提供出色的统计能力，并在COS和时间上的出色效率来解决以下特定目的：1。评估抑郁症是否会增加发生乳腺癌的风险，而乳腺癌是否独立于AD使用； 2。评估AD使用对事件乳腺癌风险的影响；和3。确定AD使用对循环催乳素水平的影响。这将是首次全面评估抑郁症，AD使用和乳腺癌之间关系的研究，并检查AD在大型基于人群的样本中循环催乳素水平的影响。这项研究将为考虑抑郁症治疗的风险和益处的临床医生和患者提供重要的新信息。我们的结果可以填补知识库中的关键空白，同时为进一步研究提供基础（例如，SSRI使用的催乳素水平变化与事件乳腺癌的变化有关）。