TY - JOUR

T1 - Risk of cancer in bipolar disorder and the potential role of lithium

T2 - International collaborative systematic review and meta-analyses

AU - Anmella, Gerard

AU - Fico, Giovanna

AU - Lotfaliany, Mojtaba

AU - Hidalgo-Mazzei, Diego

AU - Soto-Angona, Óscar

AU - Giménez-Palomo, Anna

AU - Amoretti, Silvia

AU - Murru, Andrea

AU - Radua, Joaquim

AU - Solanes, Aleix

AU - Pacchiarotti, Isabella

AU - Verdolini, Norma

AU - Cowdery, Stephanie

AU - Dodd, Seetal

AU - Williams, Lana J.

AU - Mohebbi, Mohammadreza

AU - Carvalho, Andre F.

AU - Kessing, Lars Vedel

AU - Vieta, Eduard

AU - Berk, Michael

PY - 2021

Y1 - 2021

N2 - We examined bipolar disorder (BD) as a risk factor for developing cancer and the role of lithium on cancer incidence. We conducted two systematic review and meta-analyses of population-based studies providing data on these associations. We screened articles indexed in MEDLINE, Scopus, Embase, and PsycINFO up to August 2020. The first random-effects meta-analysis, based on 4,910,661 individuals from nine studies estimated an increased risk of cancer of any kind [RR = 1.24 (1.05–1.46); p < 0.01], especially breast cancer [RR = 1.33 (1.15–1.55); p < 0.01] in BD. The second random-effects meta-analysis, based on 2,606,187 individuals from five studies did not show increased risk of cancer in people with BD using lithium, and even suggested a small protective effect both in overall [RR = 0.94 (0.72–1.22); p = 0.66] and urinary cancer [RR = 0.93 (0.75–1.14); p = 0.48] although these findings did not reach statistical significance. The current evidence highlights that cancer risk is increased in individuals with BD, particularly breast cancer in women. Lithium may have a potential protective effect on cancer, including urinary cancer. The role of lithium as a mainstay of treatment for BD is reinforced by this study.

AB - We examined bipolar disorder (BD) as a risk factor for developing cancer and the role of lithium on cancer incidence. We conducted two systematic review and meta-analyses of population-based studies providing data on these associations. We screened articles indexed in MEDLINE, Scopus, Embase, and PsycINFO up to August 2020. The first random-effects meta-analysis, based on 4,910,661 individuals from nine studies estimated an increased risk of cancer of any kind [RR = 1.24 (1.05–1.46); p < 0.01], especially breast cancer [RR = 1.33 (1.15–1.55); p < 0.01] in BD. The second random-effects meta-analysis, based on 2,606,187 individuals from five studies did not show increased risk of cancer in people with BD using lithium, and even suggested a small protective effect both in overall [RR = 0.94 (0.72–1.22); p = 0.66] and urinary cancer [RR = 0.93 (0.75–1.14); p = 0.48] although these findings did not reach statistical significance. The current evidence highlights that cancer risk is increased in individuals with BD, particularly breast cancer in women. Lithium may have a potential protective effect on cancer, including urinary cancer. The role of lithium as a mainstay of treatment for BD is reinforced by this study.

KW - Bipolar disorder

KW - Breast cancer

KW - Cancer

KW - Lithium

KW - Neuroscience

KW - Psychiatry

KW - Urinary cancer

U2 - 10.1016/j.neubiorev.2021.03.034

DO - 10.1016/j.neubiorev.2021.03.034

M3 - Review

C2 - 33831461

AN - SCOPUS:85104292731

VL - 126

SP - 529

EP - 541

JO - Neuroscience & Biobehavioral Reviews

JF - Neuroscience & Biobehavioral Reviews

SN - 0149-7634

ER -