Schizophrenia and Breast Cancer
Unlike yesterday's posting about tamoxifen, this is a topic that is not likely to have direct relevance to many readers. However, I am fascinated by this report from Sharma and colleagues in the UK that suggests that a pre-existing diagnosis of schizophrenia does not adversely impact a woman's breast cancer treatment.
Here is the background to my interest: Over my many years of doing this work, I have repeatedly noticed that women with a serious mental illness invariably do better with their cancer than predicted. I don't only mean that their coping and behavior often seems to improve, but that, even with advanced disease, they physically do very well, often outliving the prediction by months or even years. I have talked with colleagues about this observation, and have several ideas, but no proof. I wonder whether the increased attention and care makes a positive difference in daily functioning; that one seems likely. There may also be some kind of biochemical response that is different. We know that mental illness involves changes in brain and physiological mechanisms; we don't know if these differences somehow enhance the metabolism and effectiveness of some chemotherapy agents. I am way over my head with that one. The fact remains that, over and over, I have known women who were very limited and troubled before their cancer diagnosis and who then did extremely well under our auspices.
A slight tangent: Years ago at a support group meeting, one woman talked about her sister who was bipolar and had been hospitalized, again, about the same time that my patient's breast cancer had been diagnosed. Commenting on the differences in support for them, she said: "No one brings casseroles when you are mentally ill."
Here is the abstract from Science Direct:
Schizophrenia does not adversely affect the
treatment of women with breast cancer: A cohort
Anand Sharmaa, Sarah Ngana, Ashwini
Nandoskara, Charles Lowdella, Jacqueline S.
Lewisa, Katy Hogbena, R. Charles Coombesa and
Justin Stebbing , a,
a Departments of Oncology and Surgery, Imperial
College Healthcare NHS Trust, Charing Cross
Hospital, Fulham Palace Road, London W6 8RF, UK
Received 19 December 2009; revised 21 March 2010; accepted 7 April 2010. Available
online 5 May 2010.
Data on the natural course of patients with breast cancer and schizophrenia are limited.
Although there have been studies in assessing the incidence of breast cancer in the setting of schizophrenia, there is very little information concerning the clinical profile of these women.
We analyzed the data from our electronic notes system by searching for the terms 'schizophrenia' or 'schizophrenic' and 'breast cancer' or 'tumour' between 1993 and 2009. Information was collected on demographics, clinico-pathologic disease variables, treatment including anti-emetic use, chemotherapy delivery and outcomes.
From 90,676 patients screened, we identified 37 individuals who had breast cancer and a pre-existing underlying diagnosis of schizophrenia. Of these, 30 (81%) presented with early breast cancer and 7 (19%) presented with metastatic disease. Node positivity was observed in 14 individuals (38%). The average interval between diagnosis of schizophrenia and breast cancer was more than 20 years in the majority of the patients.
Treatment outcomes, trial involvement, compliance and ability to provide informed consent were similar to our previously published cohort data.
Schizophrenia does not affect treatment delivery or outcomes in women with breast cancer. The presence of schizophrenia should not be a limiting factor for entry into clinical trials. Breast cancer patients with this illness should be offered standard treatment without discrimination, including entry into clinical trials.