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Cancer incidence in young and middle-aged people with schizophrenia: nationwide cohort study in Taiwan, 2000–2010

Published online by Cambridge University Press:  21 November 2016

L. Y. Chen ,
Y. N. Hung ,
Y. Y. Chen ,
S. Y. Yang ,
C. H. Pan ,
C. C. Chen  and
C. J. Kuo
L. Y. Chen
Affiliation:
Taipei City Psychiatric Center, Songde Branch, Taipei City Hospital, Taipei, Taiwan Department of Psychiatry, National Cheng Kung University, Tainan, Taiwan
Y. N. Hung
Affiliation:
School of Gerontology Health Management and Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Tainan, Taiwan
Y. Y. Chen
Affiliation:
Taipei City Psychiatric Center, Songde Branch, Taipei City Hospital, Taipei, Taiwan Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan
S. Y. Yang
Affiliation:
Taipei City Psychiatric Center, Songde Branch, Taipei City Hospital, Taipei, Taiwan Graduate Institute of Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
C. H. Pan
Affiliation:
Taipei City Psychiatric Center, Songde Branch, Taipei City Hospital, Taipei, Taiwan
C. C. Chen
Affiliation:
Department of Psychiatry, School of Medicine, Taipei Medical University and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
C. J. Kuo*
Affiliation:
Taipei City Psychiatric Center, Songde Branch, Taipei City Hospital, Taipei, Taiwan Department of Psychiatry, School of Medicine, Taipei Medical University and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
*
*Address for correspondence: C. J. Kuo, MD, Ph.D., Department of General Psychiatry, Taipei City Psychiatric Center, 309 Sung-Te Road, Taipei 110, Taiwan. (Email: tcpckuo@seed.net.tw)
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Abstract

Aims.

For nearly a century, the incidence of cancer in people with schizophrenia was lower than in the general population. In the recent decade, the relationship between cancer and schizophrenia has become obscured. Thus, we investigated the cancer risk among young and middle-aged patients with schizophrenia.

Methods.

Records of newly admitted patients with schizophrenia (n = 32 731) from January 2000 through December 2008 were retrieved from the Psychiatric Inpatient Medical Claims database in Taiwan, and the first psychiatric admission of each patient during the same period was defined as the baseline. We obtained 514 incident cancer cases that were monitored until December 2010. Standardised incidence ratios (SIRs) were calculated to compare the risk of cancer between those with schizophrenia and the general population. Stratified analyses of cancer incidences were performed by gender, site of cancers and duration since baseline (first psychiatric admission).

Results.

The incidence of cancer for all sites was slightly higher than that of the general population for the period (SIR = 1.15 [95% CI 1.06–1.26], p = 0.001). Men had a significantly higher incidence of colorectal cancer (SIR = 1.48 [95% CI 1.06–2.06], p = 0.019). Women had a higher incidence of breast cancer (SIR = 1.47 [95% CI 1.22–1.78], p < 0.001). Intriguingly, the risk for colorectal cancer was more pronounced 5 years after the first psychiatric admission rather than earlier (SIR = 1.94 [1.36–2.75], p < 0.001) and so was the risk for breast cancer (SIR = 1.85 [1.38–2.48], p < 0.001). The cancer incidence was higher in patients with schizophrenia contradicting the belief that schizophrenia was protective of cancers.

Conclusions.

Our analyses suggest that men and women with schizophrenia were more vulnerable to certain types of cancers, which indicates the need for gender-specific cancer screening programs. The fact that risk of colorectal cancer was more pronounced 5 years after the first psychiatric admission could imply the impact of unhealthy lifestyles or the possibility of delayed diagnoses.

Keywords

Breast cancercancercolorectal cancerschizophreniastandardised incidence ratio (SIR)
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 27 , Issue 2 , April 2018 , pp. 146 - 156
Copyright
Copyright © Cambridge University Press 2016 

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