According to the CDC, suicide rates increased approximately 36% from 2000 to 2022, the last year for which data are reported. One death by suicide occurs every 11 minutes, resulting in 49,476 deaths in 2022. The number of people who think about or attempt suicide is even higher. In 2022, an estimated 13.2 million adults seriously thought about suicide, 3.8 million planned a suicide attempt, and 1.6 million attempted suicide.

September is National Suicide Prevention Month. The purpose of this month is to raise awareness of suicide prevention. This is especially relevant given that the risk of suicide may be underestimated in cancer patients. Among cancer patients, those who have had breast cancer (BC) may be especially at risk due to change in body image, infertility issues, chemotherapy-induced cognitive impairment, alterations in sexual relationships, other social role difficulties, and financial challenges. Yet very little is known about this potential for harm.

Using data from the National Cancer Institute’s Surveillance, Epidemiology, and End Result (SEER) Program, which provides information on cancer statistics for approximately 35% of the U.S. population, investigators conducted a retrospective cohort study of risk factors for suicide death among women with BC in the United States from 2010 to 2018.

Death by suicide among BC patients was compared with suicide rates of the U.S. general population collected from a web-based Fatal Injury and Violence Data Report from the CDC. Women aged 20 years or older with a diagnosis of primary malignant BC during the study period were included in the study. Male BC patients, cases with no diagnosis or microscopic confirmation based solely on autopsy or death certificate, or those missing values in survival months were excluded.

A total of 716,422 female BC patients were identified, among which there were 245 suicide deaths. These statistics were used to calculate a standardized mortality ratio (SMR) for BC patients. SMR is the ratio of the observed suicide deaths to the expected suicide deaths. During this time, there were 155 suicide deaths among the general population. The suicide rate for BC patients was 9.02 per 100,000 person-years compared with a suicide rate of 5.71 per 100,000 person-years for the general population. This resulted in a SMR of 1.58 (245/155; 95% CI, 1.39-1.79) for women with BC based on the expected suicide rate in the U.S. general population. The SMR was higher among patients aged >70 years.

To calculate a Cox proportional-hazards regression model for risk factors for suicide deaths, patients with missing demographic or tumor-related data were excluded. This resulted in a sample size of 72,729 patients, of which there were 203 suicide deaths.

The major risk factors for suicide death were white race, being non-Hispanic, and being single/unmarried. There was a significant difference between black and white races and between black and other races, with black race appearing to be protective against suicide. Other risk factors associated with suicide death include having stage II or III BC and being aged 70 to 79 years. Conversely, receiving radiotherapy was associated with a lower risk of suicide death.

In 2023, the American Journal of Pharmaceutical Education published a scoping review on suicide prevention training programs for pharmacists and pharmacy students. Such programs may help prepare the pharmacy workforce for encounters with patients in crisis.

Pharmacists can play an active role in suicide prevention for their patients with BC who are contemplating suicide by recognizing the signs of suicide; asking about whether the patient has a suicidal plan; validating the patient’s feelings by being nonjudgmental, listening, and allowing them to talk about their mental state; connecting the patient with local mental health services; monitoring the patient’s medication use; and following up with the patient to determine if the crisis has passed. Additionally, pharmacists should be trained in Mental Heart First Aid (MHFA). Organizations such as the National Community Pharmacists Association offer courses in MHFA, as does the National Council for Mental Wellbeing.

In addition to helping their BC patients, pharmacists also need to seek help when they are in crisis as pharmacists are at increased risk of suicide. In 2023, the American Society of Health-System Pharmacists and the American Pharmacists Association designated September 20th as Pharmacy Workforce Suicide Awareness Day.

Pharmacists are advised to refer BC patients (or colleagues) who are struggling with suicidal thoughts or mental health matters to call the 988 Suicide & Crisis Lifeline by dialing 988 to connect with a trained counselor or visit the 988 Lifeline website at https://988lifeline.org/.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.