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J Am Acad Dermatol. 2018 Apr;78(4):673-681.e9. doi: 10.1016/j.jaad.2017.11.042. Epub 2017 Dec 4.

Hydrochlorothiazide use and risk of nonmelanoma skin cancer: A nationwide case-control study from Denmark.

Author information

1
Department of Neurology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, Odense, Denmark; Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.
2
Department of Neurology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, Odense, Denmark.
3
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
4
Department of Plastic Surgery, Herlev-Gentofte Hospital, Herlev, Denmark.
5
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
6
Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark. Electronic address: apottegaard@health.sdu.dk.

Abstract

BACKGROUND:

Hydrochlorothiazide, one of the most frequently used diuretic and antihypertensive drugs in the United States and Western Europe, is photosensitizing and has previously been linked to lip cancer.

OBJECTIVE:

To examine the association between hydrochlorothiazide use and the risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

METHODS:

From the Danish Cancer Registry, we identified patients (cases) with nonmelanoma skin cancer (NMSC) during 2004-2012. Controls were matched 1:20 by age and sex. Cumulative hydrochlorothiazide use (in 1995-2012) was assessed from the Danish Prescription Registry. Using conditional logistic regression, we calculated odds ratios (ORs) for BCC and SCC associated with hydrochlorothiazide use.

RESULTS:

High use of hydrochlorothiazide (≥50,000 mg) was associated with ORs of 1.29 (95% confidence interval [CI], 1.23-1.35) for BCC and 3.98 (95% CI, 3.68-4.31) for SCC. We found clear dose-response relationships between hydrochlorothiazide use and both BCC and SCC; the highest cumulative dose category (≥200,000 mg of HCTZ) had ORs of 1.54 (95% CI, 1.38-1.71) and 7.38 (95% CI, 6.32-8.60) for BCC and SCC, respectively. Use of other diuretics and antihypertensives was not associated with NMSC.

LIMITATIONS:

No data on sun exposure were available.

CONCLUSIONS:

Hydrochlorothiazide use is associated with a substantially increased risk of NMSC, especially SCC.

KEYWORDS:

antihypertensives; cancer risk; hydrochlorothiazide; nonmelanoma skin cancer; pharmacoepidemiology; pharmacology; skin cancer

PMID:
29217346
DOI:
10.1016/j.jaad.2017.11.042
[Indexed for MEDLINE]
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