title: Antidepressants and breast and ovarian cancer risk: a review of the literature and researchers' financial associations with industry.
abstract: BACKGROUND
  Antidepressant (AD) use has been purported to increase the risk of breast and ovarian cancer, although both epidemiological and pre-clinical studies have reported mixed results. Previous studies in a variety of biomedical fields have found that financial ties to drug companies are associated with favorable study conclusions.
  
  
  RESULTS
  We searched English-language articles in MEDLINE, PsychINFO, the Science Citations Index and the Cochrane Central Register of Controlled Clinical Trials (through November 2010). A total of 61 articles that assessed the relationship between breast and ovarian cancer and AD use and articles that examined the effect of ADs on cell growth were included. Multi-modal screening techniques were used to investigate researchers' financial ties with industry. A random effects meta-analysis was used to pool the findings from the epidemiological literature. Thirty-three percent (20/61) of the studies reported a positive association between ADs and cancer. Sixty-seven percent (41/61) of the studies reported no association or antiproliferative effect. The pooled odds ratio for the association between AD use and breast/ovarian cancer in the epidemiologic studies was 1.11 (95% CI, 1.03-1.20). Researchers with industry affiliations were significantly less likely than researchers without those ties to conclude that ADs increase the risk of breast or ovarian cancer. (0/15 [0%] vs 20/46 [43.5%] (Fisher's Exact test P = 0.0012).
  
  
  CONCLUSIONS
  Both the pre-clinical and clinical data are mixed in terms of showing an association between AD use and breast and ovarian cancer. The possibility that ADs may exhibit a bi-phasic effect, whereby short-term use and/or low dose antidepressants may increase the risk of breast and ovarian cancer, warrants further investigation. Industry affiliations were significantly associated with negative conclusions regarding cancer risk. The findings have implications in light of the 2009 USPSTF guidelines for breast cancer screening and for the informed consent process.
authors.affiliation: The Edmond J. Safra Center for Ethics, Harvard University, Cambridge, Massachusetts, United States of America. lcosgrove@ethics.harvard.edu
authors.forename: Lisa
authors.initials: L
authors.lastname: Cosgrove
authors.forename: Ling
authors.initials: L
authors.lastname: Shi
authors.forename: David E
authors.initials: DE
authors.lastname: Creasey
authors.forename: Maria
authors.initials: M
authors.lastname: Anaya-McKivergan
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Myers
authors.forename: Krista F
authors.initials: KF
authors.lastname: Huybrechts
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects* / Q000191:economics*; D001499:Bayes Theorem; D001943:Breast Neoplasms / Q000191:economics* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007221:Industry / Q000191:economics*; D010051:Ovarian Neoplasms / Q000191:economics* / Q000453:epidemiology; D017594:Publication Bias; D012108:Research Personnel / Q000191:economics*; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents