Hyperprolactinemia-inducing antipsychotics increase breast cancer risk by activating JAK-STAT5 in precancerous lesions

Breast Cancer Res. 2018 May 19;20(1):42. doi: 10.1186/s13058-018-0969-z.


Background: Psychiatric medications are widely prescribed in the USA. Many antipsychotics cause serum hyperprolactinemia as an adverse side effect; prolactin-Janus kinase 2 (JAK2)-signal transducer and activator of transcription 5 (STAT5) signaling both induces cell differentiation and suppresses apoptosis. It is controversial whether these antipsychotics increase breast cancer risk.

Methods: We investigated the impact of several antipsychotics on mammary tumorigenesis initiated by retrovirus-mediated delivery of either ErbB2 or HRas or by transgenic expression of Wnt-1.

Results: We found that the two hyperprolactinemia-inducing antipsychotics, risperidone and pimozide, prompted precancerous lesions to progress to cancer while aripiprazole, which did not cause hyperprolactinemia, did not. We observed that risperidone and pimozide (but not aripiprazole) caused precancerous cells to activate STAT5 and suppress apoptosis while exerting no impact on proliferation. Importantly, we demonstrated that these effects of antipsychotics on early lesions required the STAT5 gene function. Furthermore, we showed that only two-week treatment of mice with ruxolitinib, a JAK1/2 inhibitor, blocked STAT5 activation, restored apoptosis, and prevented early lesion progression.

Conclusions: Hyperprolactinemia-inducing antipsychotics instigate precancerous cells to progress to cancer via JAK/STAT5 to suppress the apoptosis anticancer barrier, and these cancer-promoting effects can be prevented by prophylactic anti-JAK/STAT5 treatment. This preclinical work exposes a potential breast cancer risk from hyperprolactinemia-inducing antipsychotics in certain patients and suggests a chemoprevention regime that is relatively easy to implement compared to the standard 5-year anti-estrogenic treatment in women who have or likely have already developed precancerous lesions while also requiring hyperprolactinemia-inducing antipsychotics.

Keywords: Antipsychotics; Breast cancer; Cancer; JAK; Mammary gland; Neuroleptics; Prolactin; Ruxolitinib; STAT5.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Animals
  • Antipsychotic Agents / adverse effects
  • Apoptosis / drug effects
  • Breast / drug effects
  • Breast / pathology
  • Breast Neoplasms / chemically induced
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / genetics*
  • Breast Neoplasms / pathology
  • Cell Differentiation / drug effects
  • Female
  • Humans
  • Hyperprolactinemia / chemically induced
  • Hyperprolactinemia / epidemiology
  • Hyperprolactinemia / genetics
  • Hyperprolactinemia / pathology
  • Janus Kinase 2 / genetics*
  • Mice
  • Pimozide / adverse effects
  • Precancerous Conditions / chemically induced
  • Precancerous Conditions / genetics*
  • Precancerous Conditions / pathology
  • Risk Factors
  • Risperidone / adverse effects
  • STAT5 Transcription Factor / genetics*
  • Signal Transduction / drug effects


  • Antipsychotic Agents
  • STAT5 Transcription Factor
  • Pimozide
  • Janus Kinase 2
  • Risperidone