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Incidence of Cancer Among Persons With Schizophrenia and Their Relatives
Dirk Lichtermann, MD;
Jesper Ekelund, MD;
Eero Pukkala, PhD;
Antti Tanskanen, MSc;
Jouko Lönnqvist, MD, PhD
Arch Gen Psychiatry. 2001;58:573-578.
Background It has repeatedly been reported that the risk for cancer in patients
with schizophrenia is different from that of the general population, specifically
a lower risk for lung cancer despite increased smoking. Confirmation of these
associations could lead to hypotheses on shared risk or protective factors,
either genetic or environmental.
Methods From Finland's National Hospital Discharge and Disability Pension registers,
Helsinki, we identified a cohort of 26 996 individuals born between 1940
and 1969 and treated for schizophrenia between 1969 and 1991. They were followed
up for cancer from 1971 to 1996 by record linkage with the Finnish Cancer
Registry, yielding 446 653 person-years at risk, and standardized incidence
ratios (SIRs) were calculated. Likewise, 39 131 parents and 52 976
siblings of the patients with schizophrenia were followed up to explore familial
genetic hypotheses on deviations in cancer risk.
Results In patients with schizophrenia, an increased overall cancer risk was
found (724 cases observed vs 619 expected; SIR, 1.17; 95% confidence interval
[CI], 1.09-1.25). Half of the excess cases were attributable to lung cancer
(SIR, 2.17; 95% CI, 1.78-2.60), and the strongest relative increase in risk
was in pharyngeal cancer (SIR, 2.60; 95% CI, 1.25-4.77). Cancer incidence
in siblings (SIR, 0.89; 95% CI, 0.83-0.94) and parents (SIR, 0.91; 95% CI,
0.89-0.93) was consistently lower than that in the general population.
Conclusion Although specific lifestyle factors, particularly tobacco smoking and
alcohol consumption, probably account for the increased cancer risk in patients
with schizophrenia, the decreased risk in relatives would be compatible with
a postulated genetic risk factor for schizophrenia offering selective advantage
to unaffected relatives.
From the Departments of Human Molecular Genetics (Drs Lichtermann and
Ekelund) and Mental Health and Alcohol Research (Drs Lichtermann, Ekelund,
and Lönnqvist and Mr Tanskanen), National Public Health Institute, Helsinki,
Finland; and the Finnish Cancer Registry, Institute for Statistical and Epidemiological
Cancer Research, Helsinki (Dr Pukkala). Dr Lichtermann is now with the Department
of Psychiatry, University of Bonn, Bonn, Germany. Drs Lichtermann and Ekelund
contributed equally to the article.
Corresponding author and reprints: Dirk Lichtermann, MD, Department
of Psychiatry, University of Bonn, Sigmund-Freud-Str 25, D-53105 Bonn, Germany
(e-mail: lichtermann{at}uni-bonn.de).
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