Expert Commentary

Association between breast cancer and depression may last as long as 8 years

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A large Danish cohort study clarifies the risk factors for depression after a diagnosis of breast cancer, which include advanced age, comorbidities, node-positive disease, and living alone


 

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Although it is generally accepted that women given a diagnosis of breast cancer are vulnerable to depression, studies investigating this association have been hampered by cross-sectional design, a short duration of follow-up, or a lack of clinical detail. In a new study from Denmark, Suppli and colleagues used the national health database to identify almost 2 million women with no history of cancer or inpatient care for depression whom they followed from 1988 to 2011. They identified incident cases of breast cancer in this population, as well as prescriptions for antidepressants and inpatient care for depression during the follow-up period.1

What they found may surprise you: Not only were women given a diagnosis of breast cancer three times more likely to fill a prescription for an antidepressant in the first year after diagnosis (rate ratio, 3.09; 95% confidence interval [CI], 2.95–3.22), but the rate ratio remained significantly elevated as far out as 8 years after diagnosis.

Suppli and colleagues also found that the rate ratio for hospitalization for depression was 1.70 in the first year (95% CI, 1.41–2.05). It, too, remained significantly elevated as far out as 5 years after diagnosis.

Women who were age 70 or older at the time of diagnosis were more likely to be treated for depression and to be hospitalized. Other risk factors for depression included comorbidity, node-positive disease, basic and vocational educational levels, and living alone.

The type of cancer treatment the women underwent appeared to have no bearing on the risk of depression.

What we can do about the risk of depression in cancer patients
The finding that breast cancer is associated with depression is not new, but the magnitude of the association documented in this large study from a Danish national registry clarifies the role of women’s health providers: We need to be mindful of the long-term impact this disease can have on our patients’ mental health so that we are better able to recognize and proactively address mood disorders in this vulnerable population.

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