嚴重心智疾病會使癌症風險加倍


  【24drs.com】一篇新研究認為,精神分裂症或躁鬱症成人的癌症風險增加超過2倍,特別是肺癌;研究為嚴重心智疾病患者的癌症風險較高增添證據。
  
  美國約翰霍普金斯大學醫學院Gail L. Daumit醫師等人指出,這些最新的結果認為,需要有更多努力,以改善精神分裂症病患的癌症預防和早期偵測。他們建議,醫師和心智健康體系管理當局、以及一線照護者,對於嚴重心智疾病患者,都應促進適當的癌症篩檢,並努力降低可修飾的風險因素,如抽菸。
  
  研究結果刊載於7月的Psychiatric Services期刊。
  
  Daumit醫師等人於1994-2004年間追蹤Medicaid的3,317名成人保戶(精神分裂症(n = 2315人)、躁鬱症(n = 1002人)),確認其癌症發生率。
  
  對於精神分裂症或躁鬱症成人,與一般美國人口(資料來自監測流行病學與最終結果[SEER]計畫)相比,任何癌症的標準化發生率比率(SIR)為2.6(95%信心區間[CI]2.2 - 3.0)。
  
  根據癌症部位,肺癌的風險最大—精神分裂症成人的SIR為4.7 (95% CI,3.1 - 6.8),躁鬱症者為4.1 (95% CI,2.2 - 7.2);風險次高的為結腸直腸癌—精神分裂症成人的SIR為3.5 (95% CI,2.1 - 5.5),躁鬱症者為4.0 (95% CI,2.0 - 7.2)。
  
  精神分裂症或躁鬱症婦女發生乳癌的風險也較高 — SIR分別是2.9 (95% CI,2.1 - 3.9)和1.9 (95% CI,1.1 - 3.0)。
  
  研究者寫道,嚴重心智疾病者的抽菸率較高,可能會導致肺癌發生,研究認為,因為使用特定精神科藥物增加泌乳激素值和降低生育率,可能會造成婦女乳癌風險升高,不過尚無結論。
  
  他們指出,造成結腸癌的高風險因素則較少暸解,但是可能與抽菸、久坐生活型態、高脂低蔬果飲食等因素有關。
  
  研究者發現,黑人和白人Medicaid保戶的風險沒有差異。
  
  研究者指出,對於嚴重心智疾病者,暸解行為和藥物因素如何增加癌症風險、以及探討有關哪些人接受適當癌症篩檢與治療的更多資料,對於改善這群人的健康至關重要。
  
  最近一篇研究顯示,對於精神分裂症患者,次高的死因為惡性腫瘤,特別是乳癌和肺癌,且其癌症死亡率比一般人口高50%(Limosin等人Cancer 2009:15;3555-62)。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6909&x_classno=0&x_chkdelpoint=Y
  

Serious Mental Illness Can Double Cancer Risk

By Megan Brooks
Medscape Medical News

August 10, 2012 — Adults with schizophrenia or bipolar disorder have a greater than 2-fold increased risk for cancer, particularly lung cancer, a new study suggests.

This study adds to a growing body of research suggesting a higher risk for cancer in patients with serious mental illness.

These latest results suggest that extra efforts should be made to improve cancer prevention and early detection in patients with schizophrenia, Gail L. Daumit, MD, MHS, from Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues note.

"Clinicians and mental health system administrators, together with primary care providers, should promote appropriate cancer screening and work to reduce modifiable risk factors, such as smoking, among persons with serious mental illness," they advise.

The study is published in the July issue of Psychiatric Services.

Lifestyle to Blame?

Dr. Daumit and colleagues determined cancer incidence in a cohort of 3317 adult Medicaid beneficiaries with schizophrenia (n = 2315) and bipolar disorder (n = 1002) who were followed from 1994 through 2004.

Compared with the general US population (data from the Surveillance Epidemiology and End Results [SEER] program), the standardized incidence ratio (SIR) for any cancer was 2.6 (95% confidence interval [CI], 2.2 - 3.0) in adults with schizophrenia or bipolar disorder.

By cancer site, the risk was greatest for lung cancer — SIR of 4.7 (95% CI, 3.1 - 6.8) in adults with schizophrenia and 4.1 (95% CI, 2.2 - 7.2) in those with bipolar disorder.

The next greatest risk was for colorectal cancer — SIR, 3.5 (95% CI, 2.1 - 5.5) for schizophrenia and 4.0 (95% CI, 2.0 - 7.2) for bipolar disorder.

Women with schizophrenia or bipolar disorder had a heightened risk of developing breast cancer — SIR, 2.9 (95% CI, 2.1 - 3.9) and 1.9 (95% CI, 1.1 - 3.0), respectively.

"High rates of smoking in the population with serious mental illness likely contribute to lung cancer incidence, and research suggests a possible but inconclusive elevated risk of breast cancer due to low rates of childbearing and increased prolactin levels caused by use of particular psychotropic medications," the investigators write.

"The risk factors contributing to high risk of colon cancer are less understood but may be related to smoking, a sedentary lifestyle, or a diet high in fat and low in fruits and vegetables," they note.

The investigators found no difference in risk for black vs white Medicaid beneficiaries.

The researchers note a "better understanding of how behavioral and pharmacological factors increase cancer risk among persons with serious mental illness, and more information on the extent to which the population receives appropriate cancer screening and treatment, are important in order to improve health in this vulnerable group."

As reported by Medscape Medical News, a recent study showed that malignancies, especially of the breast and lung, are the second most common cause of death in people with schizophrenia, whose risk for cancer death is 50% higher than that of the general population (Limosin et al, Cancer 2009:15;3555-62).

Funding for the study was provided by the National Institute of Mental Health. The authors have disclosed no relevant financial relationships.

Psychiatr Serv. 2012:63:714-7.

    
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