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Breast Cancer Death Risk May Be Increased By Antidepressant

Breast Cancer Death Risk May Be Increased By Antidepressant

Glasgow Herald

February 09, 2010

A popular antidepressant could interfere with a breast cancer drug and lead to a greater risk of death, researchers have said.

Women taking the antidepressant paroxetine (brand name Seroxat) alongside tamoxifen for breast cancer were more likely to die from the disease than women on other antidepressants, a study found.

The researchers, writing in the British Medical Journal (BMJ), said their results had “major implications for clinical practice”.

Tamoxifen is taken by thousands of British women each year and works by blocking the female sex hormone oestrogen, which can fuel tumour growth.

It is generally given for up to five years after initial treatment or surgery.

The latest research was led by a team from the Sunnybrook Health Sciences Centre and the University of Toronto in Canada.

Up to one in four women with breast cancer experiences some degree of depression and antidepressants are also prescribed for hot flushes, they said.

A total of 2,430 women aged over 66 took part in the research, which looked at those having treatments between 1993 and 2005. All the women were taking tamoxifen and one of five anti-depressants known as selective serotonin reuptake inhibitors (SSRIs), including paroxetine, which was the most commonly prescribed drug.

Over a typical follow-up of 2.4 years, 374 women died from breast cancer.

Analysis of health records showed women taking paroxetine were far more likely to die from breast cancer and were slightly more likely to die from any other cause when compared with women not on paroxetine.

The researchers, who believe paroxetine interferes with the metabolism of tamoxifen, found no evidence that other SSRIs increased the risk of death.

They concluded: "After adjustment for age, duration of tamoxifen treatment, and other potential confounders, absolute increases of 25%, 50%, and 75% in the proportion of time on tamoxifen with overlapping use of paroxetine were associated with 24%, 54%, and 91% increases in the risk of death from breast cancer, respectively.

"We estimate that use of paroxetine for 41% of tamoxifen treatment (the median overlap in our sample) would result in one additional breast cancer death within five years of cessation of tamoxifen for every 19.7 patients so treated.

“In conclusion, our findings indicate that the choice of antidepressant can significantly affect survival in women receiving tamoxifen for breast cancer.”

The authors stressed that women should not stop taking tamoxifen and said their study does not imply that paroxetine itself causes or influences the course of breast cancer.

“This is simply a situation in which paroxetine impairs the effectiveness of tamoxifen,” they wrote.

Dr David Juurlink, one of the study’s authors, added: "These results highlight a drug interaction that is extremely common, widely under-appreciated and potentially life-threatening, yet uniformly avoidable.

“Tamoxifen is a crucial element of therapy for patients with hormone receptor-positive breast cancer. When co-prescription of tamoxifen with an antidepressant is necessary, preference should be given to antidepressants that exhibit little or no impact on tamoxifen’s metabolism.”

Each year more than 45,000 women are diagnosed with breast cancer in the UK and nearly 12,000 die from the disease.

Originally published by Newsquest Media Group.

© 2010 Herald, The; Glasgow (UK). Provided by ProQuest LLC. All rights Reserved.

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