title: Prolactin and breast cancer: The need to avoid undertreatment of serious psychiatric illnesses in breast cancer patients: A review.
abstract: Hyperprolactinemia, defined as a sustained elevation of prolactin (PRL) levels greater than 530 mIU/L in women and greater than 424 mIU/L in men, has been implicated for a long time in breast cancer etiology and prognosis. Elevated PRL values (approximately 2-3 times higher than the reference values) are a common adverse effect of antipsychotic medications, especially with first-generation drugs, and most antipsychotics carry a standard warning regarding PRL elevations on their US product labels. These associations foster undertreatment of serious psychiatric illnesses in both otherwise healthy patients and cancer patients. This review assesses both the preclinical and clinical evidence that has led to the hypothesis of PRL's role in breast cancer risk or breast cancer progression. It is concluded that taken together, the published data are unconvincing and insufficient to deprive cancer patients in general and breast cancer patients specifically of potentially effective antipsychotic or antidepressant medications for serious psychiatric indications. We thus call on revised medication guidelines to avoid the existing undertreatment of serious psychiatric illnesses among cancer patients based on an unproven contraindication to psychiatric medications. Cancer 2016;122:184-188. © 2015 American Cancer Society.
authors.affiliation: Avon International Breast Cancer Research Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts.|Global Cancer Institute, Boston, Massachusetts.|Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Denise
authors.initials: D
authors.lastname: Froes Brandao
authors.affiliation: Center for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Strasser-Weippl
authors.affiliation: Avon International Breast Cancer Research Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts.|Global Cancer Institute, Boston, Massachusetts.|Massachusetts General Hospital Cancer Center, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Goss
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D018567:Breast Neoplasms, Male / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006966:Hyperprolactinemia / Q000139:chemically induced / Q000150:complications*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy*; D020380:Needs Assessment; D011379:Prognosis; D011388:Prolactin / Q000097:blood*
chemical_list: D014150:Antipsychotic Agents; D011388:Prolactin
keywords: antidepressive agents; antipsychotic agents; breast neoplasms; depression; prolactin