Risk of anxiety and depression in breast cancer survivors compared to women who never had cancer: a population-based cohort study in the United Kingdom
Breast cancer survivors are the largest group of cancer survivors in the United Kingdom (UK). Having had a breast cancer diagnosis may adversely affect the patient's mental health. We aimed to estimate the long-term risk of anxiety and depression in women with history of breast cancer compared to those who never had cancer.
We conducted a matched population-based cohort study, using data from the Clinical Practice Research Datalink GOLD primary care database. The exposed cohort included all adult women diagnosed with breast cancer between 1987 and 2018; the unexposed group included women with no cancer history, matched to exposed women in a 4:1 ratio on primary care practice and age. Cox regression models stratified on matched set were used to estimate hazard ratios of the association between breast cancer survivorship and anxiety and depression.
59,972 women (mean 62 years; standard deviation (SD) 14.0) had history of breast cancer. The median follow-up time was 3.0 years (SD 4.4), which amounted to 256,186 person-years under observation. The comparison group included 240,387 women followed up over 3.5 years (SD 4.5) (1,163,819 person-years). The incidence of anxiety in breast cancer survivors was 0.08 (95% confidence interval (95%) 0.07-0.08) per 1000 person-years, and the incidence of depression was 70 (95%CI 68-71) per 1000 person-years. The risks of both depression and anxiety were raised in breast cancer survivors compared with controls, and this appeared to be driven by the first 3 years following diagnosis.
Breast cancer survivors in the UK had significantly higher risk anxiety and depression diagnosed in primary care for three years following diagnosis than women who never had cancer.