Antidepressant use and ovarian cancer risk: Evidence from nationwide studies with >14,000 cases from Denmark and Sweden

Guoqiao Zheng; Louise Baandrup; Jiangrong Wang; Rasmus Hertzum-Larsen; Charlotte Gerd Hannibal; Lina S Mørch; Mette Tuxen Faber; Karin Sundström; Susanne K Kjær

doi:10.1016/j.maturitas.2024.108009

Antidepressant use and ovarian cancer risk: Evidence from nationwide studies with >14,000 cases from Denmark and Sweden

Maturitas. 2024 Apr 25:185:108009. doi: 10.1016/j.maturitas.2024.108009. Online ahead of print.

Authors

Guoqiao Zheng¹, Louise Baandrup², Jiangrong Wang³, Rasmus Hertzum-Larsen², Charlotte Gerd Hannibal², Lina S Mørch⁴, Mette Tuxen Faber², Karin Sundström⁵, Susanne K Kjær⁶

Affiliations

¹ Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark. Electronic address: guz@cancer.dk.
² Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark.
³ Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
⁴ Cancer and Medicine, Danish Cancer Institute, Copenhagen, Denmark.
⁵ Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Clinical Pathology and Cancer Diagnostics, Medical Diagnostics Karolinska, Karolinska University Hospital, Stockholm, Sweden.
⁶ Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

PMID: 38688107
DOI: 10.1016/j.maturitas.2024.108009

Abstract

Objective: Given that the evidence regarding the link between antidepressant use and ovarian cancer risk is equivocal, we investigated this research question by conducting two nationwide nested case-control studies among the Danish and Swedish populations.

Methods: Altogether, 14,121 women with epithelial ovarian cancer (30-84 years old) (Denmark: 8976 diagnosed 2000-2019, Sweden: 5145 diagnosed 2010-2018) were randomly age-matched with 564,840 female controls (359,040 from Denmark, and 205,800 from Sweden) using risk set sampling. We used conditional logistic regression to estimate odds ratios (OR) with 95 % confidence intervals (CI) and combined the estimates based on the fixed-effect assumption. We also investigated potential effect modification by well-established risk factors for ovarian cancer.

Results: Antidepressant use was associated with an overall reduced risk of ovarian cancer (OR = 0.92, 95%CI: 0.88-0.96), and that reduction was more pronounced in postmenopausal women and long-term users. The effect was most pronounced for serous ovarian tumors (OR = 0.90, 95%CI: 0.86-0.95) but was also observed in other subtypes, although not statistically significant. Among different types of antidepressants, selective serotonin reuptake inhibitors in general and citalopram in particular exhibited a noteworthy reduction in ovarian cancer risk (OR = 0.89, 95%CI: 0.82-0.96). Additionally, use of oral contraceptives and hormone replacement therapy individually modified the association between antidepressant use and ovarian cancer risk.

Conclusions: Use of an antidepressant was associated with a slight, but statistically significant, decrease in ovarian cancer risk. Given the morbidity and mortality associated with ovarian cancer, and increasing use of antidepressants, these findings may be of significance to cancer prevention and should be studied in more detail mechanistically.

Keywords: Depression; Ovarian tumors; Pharmacoepidemiology; Selective serotonin reuptake inhibitors; Tricyclic antidepressants.