title: Suicide in breast cancer patients: an individual-centered approach provides insight beyond epidemiology.
abstract: BACKGROUND
  Epidemiologic studies have identified increased suicide rates among breast cancer (BC) patients. The population-based approach, however, has considerable methodic shortcomings. None of the studies have been carried out in a prospective manner and none reported suicide rates from a country in which physician-assisted suicide (PAS) is legal.
  
  
  METHODS
  All cases recorded by a prospective Swiss BC database during a 17-year period (1990-2006; n = 1165) were analyzed. Using an individual-centered approach, the cases of women who committed suicide are reported according to the psychological autopsy method.
  
  
  RESULTS
  In six patients (0.5%; 5.1/1.000 patients), suicidal death was identified. In four patients, suicide was committed during late stages of metastatic BC. In two cases, comorbid conditions were associated with suicide. Three women chose PAS.
  
  
  CONCLUSIONS
  The individual-centered approach is a well-suited innovative concept to increase the knowledge regarding the relationship between cancer and suicide. We found a two to seven times higher suicide rate than those reported in epidemiologic studies. The population-based approach can barely elucidate the immense variety of one of the most personal decisions: the act of intentionally ending one's own life. These studies suffer from systematic failure of analysis since they did not a) consider the potential confounding role of comorbid medical and/or psychiatric conditions, and b) report in which disease stage suicide was committed, since the decisive disease-related event whether and when metastatic disease occurred was not recorded. Furthermore, epidemiologic data stems from countries in which PAS is prohibited and therefore not included in official statistics. This grey area of medicine accounts for a greater scope of underreporting than had previously been assumed.
authors.affiliation: University Hospital Basel, Department of Gynecology and Obstetrics, Switzerland. uwe.gueth@unibas.ch
authors.forename: Uwe
authors.initials: U
authors.lastname: Güth
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Myrick
authors.forename: Thomas
authors.initials: T
authors.lastname: Reisch
authors.forename: Georg
authors.initials: G
authors.lastname: Bosshard
authors.forename: Seraina Margaretha
authors.initials: SM
authors.lastname: Schmid
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000523:psychology*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011446:Prospective Studies; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D017236:Suicide, Assisted; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D013557:Switzerland; D013997:Time Factors