Depression, Antidepressant Use, and Postmenopausal Breast Cancer Risk.
Depression, Antidepressant Use, and Postmenopausal Breast Cancer Risk.
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DOI：
10.1158/1055-9965.epi-15-1063
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发表时间：
2016-01
期刊：
影响因子：
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通讯作者：
Reeves KW
中科院分区：
文献类型：
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作者：
Brown SB;Hankinson SE;Arcaro KF;Qian J;Reeves KW
抑郁症和抗抑郁药（AD）的使用是否会影响乳腺癌的风险尚不清楚，这些暴露尚未在乳腺癌风险的单一前瞻性队列研究中进行评估。在妇女健康倡议观察性研究（WHI-OS）的71，439名绝经后妇女中，我们使用考克斯比例风险回归估计了抑郁症状和AD使用对乳腺癌风险的独立和联合影响的多变量校正风险比（HR）。当单独分析时，基线时抑郁症状和AD使用均与总乳腺癌风险显著增加无关（HR=0.96，95% CI：0.85-1.08; HR=1.04，95% CI：0.92-1.20）或浸润性乳腺癌（HR=0.98，95%CI：0.86-1.12; HR=1.00，95%CI：0.86-1.16）。在调整抑郁症状后，目前使用AD与原位乳腺癌的边缘显著性增加相关（HR=1.30，95% CI：0.99-1.75）;然而，在调整乳房X线摄影筛查后，这种关系减弱（HR=1.08，95% CI：0.76-1.51）。当探讨抑郁症状和AD使用的单独和联合影响时，未观察到总乳腺癌风险的显著变化（相互作用p =0.14）。我们没有发现抑郁或AD使用影响乳腺癌风险的证据。不能排除AD使用者原位疾病风险升高，但可能是由于该亚组筛查增加所致。鉴于这些暴露的高患病率，这些结果可能会为每年数百万抑郁和/或使用AD的女性提供保证。
Whether depression and antidepressant (AD) use might influence breast cancer risk is unclear, and these exposures have not been evaluated together in a single, prospective cohort study of breast cancer risk. Among 71,439 postmenopausal women in the Women’s Health Initiative Observational Study (WHI-OS), we estimated multivariable-adjusted hazard ratios (HRs) for the independent and joint effects of depressive symptoms and AD use on breast cancer risk using Cox proportional hazards regression. When analyzed separately, neither depressive symptoms nor AD use at baseline were associated with a significantly increased risk of total breast cancer (HR=0.96, 95% CI: 0.85–1.08; HR=1.04, 95% CI: 0.92–1.20, respectively) or invasive breast cancer (HR=0.98, 95% CI: 0.86–1.12; HR=1.00, 95% CI: 0.86–1.16, respectively). Current AD use was associated with a borderline-significant increase of in situ breast cancer (HR=1.30, 95% CI: 0.99–1.75) after adjustment for depressive symptoms; however, this relationship was attenuated after adjustment for mammographic screening (HR=1.08, 95% CI: 0.76–1.51). No significant variation in total breast cancer risk was observed when the separate and joint effects of depressive symptoms and AD use were explored (p for interaction=0.14). We found no evidence that either depression or AD use influence breast cancer risk. An elevated risk of in situ disease among AD users could not be ruled out, though is likely due to increased screening in this subgroup. Given the high prevalence of these exposures, these results may provide reassurance to the millions of women who are depressed and/or use ADs each year.