Hyperprolactinemia and cancer risk: a Swedish population-based cohort study

Prolactin (PRL) promotes cell proliferation, and PRL receptor expression is elevated in various cancer types. However, only a few studies have examined cancer risk in patients with hyperprolactinemia (HPL). The aim of this study was to investigate cancer risk in a nationwide cohort of patients with a diagnosis of HPL, with special emphasis on breast cancer.

In this Swedish population-based cohort study, we used nationwide registries to identify 3,837 patients (2,955 (77%) women) with HPL, treated with dopamine agonists (DA), diagnosed between 2006 and 2019, along with 38,370 controls matched by age, sex, calendar year and county of residence at first HPL diagnosis.

Cancer outcomes (overall and specific types), as registered in the Swedish Cancer Register, were analyzed using Cox regression, internally stratified by the matching variables and additionally adjusted for diabetes mellitus, obesity, smoking, alcohol overconsumption, hormone replacement therapy and educational level to estimate adjusted hazard ratios (aHRs).

During a median follow-up time of 6.1 years (interquartile range (IQR) 3.4-9.6), 168 (4.6%) new cases of cancer were identified in patients with HPL and 1,608 (4.4%) in the control group (aHR 1.05 (95% CI: 0.89-1.23)). Twenty-eight (0.7%) patients (all women) in the HPL group and 267 (0.7%) in the control group developed breast cancer (aHR 1.02 (95% CI: 0.68-1.51)). Similarly, there was no increased risk of any other site-specific cancer.

In this nationwide cohort study of patients with DA-treated HPL, no increased risk of overall cancer, breast cancer or other site-specific malignancies was observed.