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Cancer incidence in people with affective disorder: nationwide cohort study in Taiwan, 1997–2010

  • Yen-Ni Hung, Shu-Yu Yang, Ming-Chyi Huang, For-Wey Lung, Shih-Ku Lin, Kuan-Yu Chen, Chian-Jue Kuo and Ying-Yeh Chen...

Cancer is a serious public health problem worldwide, and its relationship with affective disorders is not clear.


To investigate alcohol- and tobacco-related cancer risk among patients with affective disorders in a large Taiwanese cohort.


Records of newly admitted patients with affective disorders from January 1997 through December 2002 were retrieved from the Psychiatric Inpatient Medical Claims database in Taiwan. Cancers were stratified by site and grouped into tobacco- or alcohol-related cancers. Standardised incidence ratios (SIRs) were calculated to compare the risk of cancer between those with affective disorders and the general population.


Some 10 207 patients with bipolar disorder and 9826 with major depression were included. The risk of cancer was higher in patients with major depression (SIR = 2.01, 95% CI 1.85–2.19) than in those with bipolar disorder (SIR 1.39, 95% CI 1.26–1.53). The elevated cancer risk among individuals ever admitted to hospital for affective disorders was more pronounced in tobacco- and/or alcohol-related cancers.


Elevated cancer risk was found in patients who had received in-patient care for affective disorders. They require holistic approaches to lifestyle behaviours and associated cancer risks.

Corresponding author
Ying-Yeh Chen, MD, ScD, Department of General Psychiatry, Taipei City Psychiatric Center, 309 Sung-Te Road, Taipei, 110, Taiwan. Email:
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These authors contributed equally to the work.

This research was supported by grants from the National Science Council (NSC102-2628-B-532-001-MY3) of Taiwan and Taipei City Hospital (10101-62-008, 10101-62-055), Taipei, Taiwan.

Declaration of interest


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1 Muller-Oerlinghausen, B, Berghofer, A, Bauer, M. Bipolar disorder. Lancet 2002; 359: 241–7.
2 Bai, YM, Su, TP, Chen, MH, Chen, TJ, Chang, WH. Risk of developing diabetes mellitus and hyperlipidemia among patients with bipolar disorder, major depressive disorder, and schizophrenia: a 10-year nationwide population-based prospective cohort study. J Affect Disord 2013; 150: 5762.
3 Lozano, R, Naghavi, M, Foreman, K, Lim, S, Shibuya, K, Aboyans, V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2095–128.
4 Jane-Llopis, E, Matytsina, I. Mental health and alcohol, drugs and tobacco: a review of the comorbidity between mental disorders and the use of alcohol, tobacco and illicit drugs. Drug Alcohol Rev 2006; 25: 515–36.
5 Dreyer, L, Winther, JF, Andersen, A, Pukkala, E. Avoidable cancers in the Nordic countries. Alcohol consumption. APMIS Suppl 1997; 76: 4867.
6 Dreyer, L, Winther, JF, Pukkala, E, Andersen, A. Avoidable cancers in the Nordic countries. Tobacco smoking. APMIS Suppl 1997; 76: 947.
7 Whitley, E, Batty, GD, Mulheran, PA, Gale, CR, Osborn, DP, Tynelius, P, et al. Psychiatric disorder as a risk factor for cancer: different analytic strategies produce different findings. Epidemiology 2012; 23: 543–50.
8 Dalton, SO, Mellemkjaer, L, Olsen, JH, Mortensen, PB, Johansen, C. Depression and cancer risk: a register-based study of patients hospitalized with affective disorders, Denmark, 1969-1993. Am J Epidemiol 2002; 155: 1088–95.
9 Beumer, W, Gibney, SM, Drexhage, RC, Pont-Lezica, L, Doorduin, J, Klein, HC, et al. The immune theory of psychiatric diseases: a key role for activated microglia and circulating monocytes. J Leukoc Biol 2012; 92: 959–75.
10 Tsai, SY, Chung, KH, Wu, JY, Kuo, CJ, Lee, HC, Huang, SH. Inflammatory markers and their relationships with leptin and insulin from acute mania to full remission in bipolar disorder. J Affect Disord 2012; 136: 110–6.
11 BarChana, M, Levav, I, Lipshitz, I, Pugachova, I, Kohn, R, Weizman, A, et al. Enhanced cancer risk among patients with bipolar disorder. J Affect Disord 2008; 108: 43–8.
12 McGinty, EE, Zhang, Y, Guallar, E, Ford, DE, Steinwachs, D, Dixon, LB, et al. Cancer incidence in a sample of Maryland residents with serious mental illness. Psychiatr Serv 2012; 63: 714–7.
13 Chen, YH, Lin, HC. Increased risk of cancer subsequent to severe depression–a nationwide population-based study. J Affect Disord 2011; 131: 200–6.
14 Rosenshfir, E, Shemesh, P, Aizenberg, D, Barak, Y. Reduced risk of cancer in patients with bipolar affective disorder. Neurosci & Med 2011; 2: 5760.
15 Liang, JA, Sun, LM, Muo, CH, Sung, FC, Chang, SN, Kao, CH. The analysis of depression and subsequent cancer risk in Taiwan. Cancer Epidemiol Biomarkers Prev 2011; 20: 473–5.
16 Possel, P, Adams, E, Valentine, JC. Depression as a risk factor for breast cancer: investigating methodological limitations in the literature. Cancer Causes Control 2012; 23: 1223–9.
17 Tsai, SY, Yang, YY, Kuo, CJ, Chen, CC, Leu, SJ. Effects of symptomatic severity on elevation of plasma soluble interleukin-2 receptor in bipolar mania. J Affect Disord 2001; 64: 185–93.
18 Hsieh, MH, Tang, CH, Hung, ST, Lee, IH, Lin, YJ, Yang, YK. Comorbid prevalence of alcohol dependence, substance abuse, and external cause of injury in patients with bipolar disorder in a nationwide representative sample in Taiwan. Bipolar Disord 2012; 14: 677–9.
19 Bai, YM, Lin, CC, Hu, PG, Yeh, HS. Risk factors for substance use disorders among inpatients with major affective disorders in Taiwan Chinese. Gen Hosp Psychiatry 1998; 20: 377–80.
20 Gau, SS, Chao, PF, Lin, YJ, Chang, CJ, Gau, CS. The association between carbamazepine and valproate and adverse cutaneous drug reactions in patients with bipolar disorder: a nested matched case-control study. J Clin Psychopharmacol 2008; 28: 509–17.
21 World Health Organization. International Statistical Classification of Diseases and Related Health Problems (ICD–9). WHO, 1978.
22 IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Tobacco smoke and involuntary smoking. IARC Monogr Eval Carcinog Risks Hum 2004; 83: 11438.
23 Baan, R, Straif, K, Grosse, Y, Secretan, B, El Ghissassi, F, Bouvard, V, et al. Carcinogenicity of alcoholic beverages. Lancet Oncol 2007; 8: 292–3.
24 IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Alcohol consumption and ethyl carbamate. IARC Monogr Eval Carcinog Risks Hum 2010; 96: 31383.
25 Woo, HD, Kim, J. Dietary flavonoid intake and smoking-related cancer risk: a meta-analysis. PLoS One 2013; 8: e75604.
26 Rothman, KJ, Greenland, S. Modern Epidemiology (2nd edn). Lippincott Williams & Wilkins, 1998.
27 Tang, CH, Hsieh, MH, Hung, ST, Lee, IH, Lin, YJ, Yang, YK. One-year post-hospital medical costs and relapse rates of bipolar disorder patients in Taiwan: a population-based study. Bipolar Disord 2010; 12: 859–65.
28 Vuorilehto, MS, Melartin, TK, Isometsa, ET. Course and outcome of depressive disorders in primary care: a prospective 18-month study. Psychol Med 2009; 39: 1697–707.
29 Heffner, JL, Strawn, JR, DelBello, MP, Strakowski, SM, Anthenelli, RM. The co?occurrence of cigarette smoking and bipolar disorder: phenomenology and treatment considerations. Bipolar Disord 2011; 13: 439–53.
30 Lasser, K, Boyd, JW, Woolhandler, S, Himmelstein, DU, McCormick, D, Bor, DH. Smoking and mental illness. JAMA 2000; 284: 2606–10.
31 Conway, KP, Compton, W, Stinson, FS, Grant, BF. Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2006; 67: 247–57.
32 Wang, PW, Lin, HC, Yeh, YC, Liu, TL, Yen, CF. The relation of substance use with different levels of depressive symptoms and the moderating effect of sex and age in Taiwanese adolescents. Compr Psychiatry 2012; 53: 1013–20.
33 Oerlemans, ME, van den Akker, M, Schuurman, AG, Kellen, E, Buntinx, F. A meta-analysis on depression and subsequent cancer risk. Clin Pract Epidemiol Ment Health 2007; 3: 29.
34 Horwath, E, Weissman, MM. Epidemiology of depression and anxiety disorders. In Textbook in Psychiatric Epidemiology (eds Tsuang, MT, Tohen, M and Zahner, GEP): 317–44. Wiley-Liss, 1995.
35 Catts, V, Catts, S, O'toole, B, Frost, A. Cancer incidence in patients with schizophrenia and their first?degree relatives–a meta?analysis. Acta Psychiatr Scand 2008; 117: 323–36.
36 Lichtermann, D, Ekelund, J, Pukkala, E, Tanskanen, A, Lonnqvist, J. Incidence of cancer among persons with schizophrenia and their relatives. Arch Gen Psychiatry 2001; 58: 573.
37 Barak, Y, Achiron, A, Mandel, M, Mirecki, I, Aizenberg, D. Reduced cancer incidence among patients with schizophrenia. Cancer 2005; 104: 2817–21.
38 Hippisley-Cox, J, Vinogradova, Y, Coupland, C, Parker, C. Risk of malignancy in patients with schizophrenia or bipolar disorder: nested case-control study. Arch Gen Psychiatry 2007; 64: 1368–76.
39 Lin, GM, Chen, YJ, Kuo, DJ, Jaiteh, LE, Wu, YC, Lo, TS, et al. Cancer incidence in patients with schizophrenia or bipolar disorder: a nationwide population-based study in Taiwan, 1997–2009. Schizophr Bull 2013; 39: 407–16.
40 Chen, YJ, Wu, CY, Chen, TJ, Shen, JL, Chu, SY, Wang, CB, et al. The risk of cancer in patients with psoriasis: a population-based cohort study in Taiwan. J Am Acad Dermatol 2011; 65: 8491.
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Cancer incidence in people with affective disorder: nationwide cohort study in Taiwan, 1997–2010

  • Yen-Ni Hung, Shu-Yu Yang, Ming-Chyi Huang, For-Wey Lung, Shih-Ku Lin, Kuan-Yu Chen, Chian-Jue Kuo and Ying-Yeh Chen...
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