Avoid these three antipsychotics in women with breast cancer

Whether use of antipsychotics is associated with an increased risk of breast cancer is controversial and has certainly not been shown.

BUT, here are some facts about prolactin, antipsychotics, and breast cancer that I think psychopharmacologists should know but seemed to come as a surprise to many clinicians I have spoken to.

Fact no. 1: Prolactin supports the growth of breast cancer cells

Fact no. 2: Women whose serum prolactin levels are on the higher side of normal have a higher risk of developing breast cancer.

Fact no. 3: Women with breast cancer whose prolactin levels are elevated have more rapid progression of the disease and increased mortality.

Based on these facts, I agree with the recommendation (Rahman et al., 2014) that in women with breast cancer

we should:

Avoid, if possible, because they are most likely to cause significant elevations in prolactin–

risperidone, paliperidone, haloperidol.

Prefer, if possible, because they are least likely to cause significant elevations in prolactin
(alphabetically)–aripiprazole, asenapine, clozapine, quetiapine, ziprasidone.