Bipolar disorder comorbidity in breast cancer: impact of genetic risk and lifestyle characteristic on breast cancer outcomes

Abstract

Bipolar disorder (BD) is associated with increased risk of breast cancer (BC), yet its impact on BC features and outcomes is unclear. We compared BC-Only patients and those with BD comorbidity (BC+BD) regarding BC characteristics and investigated associations between polygenic risk for BD (PRS-BD), a score based on common genetic variants, and BC outcomes. Methods: Female patients from the Mayo Clinic Breast Disease Registry (MCBDR), a longitudinal cohort study of patients seen at Mayo Clinic Rochester for BC, were included. BD diagnoses were ascertained through electronic health records. Clinical features of BC and lifestyle data were nurse-abstracted or patient-reported as part of MCBDR. Univariable and multivariable analyses compared BC-Only and BC+BD groups. Associations between PRS-BD and BC outcomes were examined using regression models. Results: Among the 9449 MCBDR participants (95.1 % White), 59 had a BD diagnosis prior to their BC. Age at BC diagnosis was earlier in the BC+BD group compared to BC-Only group (52.8 +/- 10.5 vs. 57.1 +/- 12.5, p = 0.005), even after adjusting for lifestyle factors including smoking, exercise, and BMI (beta=-5.88, p = 0.016). Neither cancer stage nor survival differed between groups (both p > 0.05). PRS-BD was associated with BD comorbidity but not with BC outcomes. Conclusion: BD was associated with an approximately five-year earlier BC onset, independent of lifestyle factors, which may suggest possible shared biological pathways. While PRS-BD was not associated with BC outcomes, future research should investigate the effect of rare genetic variants and medications and assess the generalizability of these findings to diverse populations and community oncology settings.