Anti-hypertensive drugs and skin cancer risk: a review of the literature and meta-analysis

Sara Gandini, Domenico Palli, Giuseppe Spadola, Benedetta Bendinelli, Emilia Cocorocchio, Ignazio Stanganelli, Lucia Miligi, Giovanna Masala, Saverio Caini

Research output: Contribution to journalReview article

Abstract

INTRODUCTION: Several anti-hypertensive drugs have photosensitizing properties, however it remains unclear whether long-term users of these drugs are also at increased risk of skin malignancies. We conducted a literature review and meta-analysis on the association between use of anti-hypertensive drugs and the risk of cutaneous melanoma and non-melanoma skin cancer (NMSC).

METHODS: We searched PubMed, EMBASE, Google Scholar and the Cochrane Library, and included observational and experimental epidemiological studies published until February 28th, 2017. We calculated summary relative risk (SRR) and 95% confidence intervals (95% CI) through random effect models to estimate the risk of skin malignancies among users of the following classes of anti-hypertensive drugs: thiazide diuretics, angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), calcium channel blockers (CCB) and β-blockers. We conducted sub-group and sensitivity analysis to explore causes of between-studies heterogeneity, and assessed publication bias using a funnel-plot based approach.

RESULTS: Nineteen independent studies were included in the meta-analysis. CCB users were at increased skin cancer risk (SRR 1.14, 95% CI 1.07-1.21), and β-blockers users were at increased risk of developing cutaneous melanoma (SRR 1.21, 95% CI 1.05-1.40), with acceptable between-studies heterogeneity (I2 < 50%). There was no association between thiazide diuretics, ACEi or ARB use and skin cancer risk. We found no evidence of publication bias affecting the results.

CONCLUSION: Family doctors and clinicians should inform their patients about the increased risk of skin cancer associated with the use of CCB and β-blockers and instruct them to perform periodic skin self-examination. Further studies are warranted to elucidate the observed associations.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalCritical Reviews in Oncology/Hematology
Volume122
DOIs
Publication statusPublished - Feb 2018

Fingerprint

Skin Neoplasms
Antihypertensive Agents
Meta-Analysis
Calcium Channel Blockers
Skin
Sodium Chloride Symporter Inhibitors
Publication Bias
Angiotensin Receptor Antagonists
Confidence Intervals
Angiotensin-Converting Enzyme Inhibitors
Melanoma
Self-Examination
Drug Users
PubMed
Libraries
Epidemiologic Studies
Neoplasms

Keywords

  • Antihypertensive Agents/administration & dosage
  • Humans
  • Melanoma/chemically induced
  • Skin Neoplasms/chemically induced

Cite this

Anti-hypertensive drugs and skin cancer risk : a review of the literature and meta-analysis. / Gandini, Sara; Palli, Domenico; Spadola, Giuseppe; Bendinelli, Benedetta; Cocorocchio, Emilia; Stanganelli, Ignazio; Miligi, Lucia; Masala, Giovanna; Caini, Saverio.

In: Critical Reviews in Oncology/Hematology, Vol. 122, 02.2018, p. 1-9.

Research output: Contribution to journalReview article

Gandini, Sara ; Palli, Domenico ; Spadola, Giuseppe ; Bendinelli, Benedetta ; Cocorocchio, Emilia ; Stanganelli, Ignazio ; Miligi, Lucia ; Masala, Giovanna ; Caini, Saverio. / Anti-hypertensive drugs and skin cancer risk : a review of the literature and meta-analysis. In: Critical Reviews in Oncology/Hematology. 2018 ; Vol. 122. pp. 1-9.
@article{f324c47fa9014d08ae4d8ddf805080b0,
title = "Anti-hypertensive drugs and skin cancer risk: a review of the literature and meta-analysis",
abstract = "INTRODUCTION: Several anti-hypertensive drugs have photosensitizing properties, however it remains unclear whether long-term users of these drugs are also at increased risk of skin malignancies. We conducted a literature review and meta-analysis on the association between use of anti-hypertensive drugs and the risk of cutaneous melanoma and non-melanoma skin cancer (NMSC).METHODS: We searched PubMed, EMBASE, Google Scholar and the Cochrane Library, and included observational and experimental epidemiological studies published until February 28th, 2017. We calculated summary relative risk (SRR) and 95{\%} confidence intervals (95{\%} CI) through random effect models to estimate the risk of skin malignancies among users of the following classes of anti-hypertensive drugs: thiazide diuretics, angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), calcium channel blockers (CCB) and β-blockers. We conducted sub-group and sensitivity analysis to explore causes of between-studies heterogeneity, and assessed publication bias using a funnel-plot based approach.RESULTS: Nineteen independent studies were included in the meta-analysis. CCB users were at increased skin cancer risk (SRR 1.14, 95{\%} CI 1.07-1.21), and β-blockers users were at increased risk of developing cutaneous melanoma (SRR 1.21, 95{\%} CI 1.05-1.40), with acceptable between-studies heterogeneity (I2 < 50{\%}). There was no association between thiazide diuretics, ACEi or ARB use and skin cancer risk. We found no evidence of publication bias affecting the results.CONCLUSION: Family doctors and clinicians should inform their patients about the increased risk of skin cancer associated with the use of CCB and β-blockers and instruct them to perform periodic skin self-examination. Further studies are warranted to elucidate the observed associations.",
keywords = "Antihypertensive Agents/administration & dosage, Humans, Melanoma/chemically induced, Skin Neoplasms/chemically induced",
author = "Sara Gandini and Domenico Palli and Giuseppe Spadola and Benedetta Bendinelli and Emilia Cocorocchio and Ignazio Stanganelli and Lucia Miligi and Giovanna Masala and Saverio Caini",
note = "Copyright {\circledC} 2017 Elsevier B.V. All rights reserved.",
year = "2018",
month = "2",
doi = "10.1016/j.critrevonc.2017.12.003",
language = "English",
volume = "122",
pages = "1--9",
journal = "Critical Reviews in Oncology/Hematology",
issn = "1040-8428",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Anti-hypertensive drugs and skin cancer risk

T2 - a review of the literature and meta-analysis

AU - Gandini, Sara

AU - Palli, Domenico

AU - Spadola, Giuseppe

AU - Bendinelli, Benedetta

AU - Cocorocchio, Emilia

AU - Stanganelli, Ignazio

AU - Miligi, Lucia

AU - Masala, Giovanna

AU - Caini, Saverio

N1 - Copyright © 2017 Elsevier B.V. All rights reserved.

PY - 2018/2

Y1 - 2018/2

N2 - INTRODUCTION: Several anti-hypertensive drugs have photosensitizing properties, however it remains unclear whether long-term users of these drugs are also at increased risk of skin malignancies. We conducted a literature review and meta-analysis on the association between use of anti-hypertensive drugs and the risk of cutaneous melanoma and non-melanoma skin cancer (NMSC).METHODS: We searched PubMed, EMBASE, Google Scholar and the Cochrane Library, and included observational and experimental epidemiological studies published until February 28th, 2017. We calculated summary relative risk (SRR) and 95% confidence intervals (95% CI) through random effect models to estimate the risk of skin malignancies among users of the following classes of anti-hypertensive drugs: thiazide diuretics, angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), calcium channel blockers (CCB) and β-blockers. We conducted sub-group and sensitivity analysis to explore causes of between-studies heterogeneity, and assessed publication bias using a funnel-plot based approach.RESULTS: Nineteen independent studies were included in the meta-analysis. CCB users were at increased skin cancer risk (SRR 1.14, 95% CI 1.07-1.21), and β-blockers users were at increased risk of developing cutaneous melanoma (SRR 1.21, 95% CI 1.05-1.40), with acceptable between-studies heterogeneity (I2 < 50%). There was no association between thiazide diuretics, ACEi or ARB use and skin cancer risk. We found no evidence of publication bias affecting the results.CONCLUSION: Family doctors and clinicians should inform their patients about the increased risk of skin cancer associated with the use of CCB and β-blockers and instruct them to perform periodic skin self-examination. Further studies are warranted to elucidate the observed associations.

AB - INTRODUCTION: Several anti-hypertensive drugs have photosensitizing properties, however it remains unclear whether long-term users of these drugs are also at increased risk of skin malignancies. We conducted a literature review and meta-analysis on the association between use of anti-hypertensive drugs and the risk of cutaneous melanoma and non-melanoma skin cancer (NMSC).METHODS: We searched PubMed, EMBASE, Google Scholar and the Cochrane Library, and included observational and experimental epidemiological studies published until February 28th, 2017. We calculated summary relative risk (SRR) and 95% confidence intervals (95% CI) through random effect models to estimate the risk of skin malignancies among users of the following classes of anti-hypertensive drugs: thiazide diuretics, angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), calcium channel blockers (CCB) and β-blockers. We conducted sub-group and sensitivity analysis to explore causes of between-studies heterogeneity, and assessed publication bias using a funnel-plot based approach.RESULTS: Nineteen independent studies were included in the meta-analysis. CCB users were at increased skin cancer risk (SRR 1.14, 95% CI 1.07-1.21), and β-blockers users were at increased risk of developing cutaneous melanoma (SRR 1.21, 95% CI 1.05-1.40), with acceptable between-studies heterogeneity (I2 < 50%). There was no association between thiazide diuretics, ACEi or ARB use and skin cancer risk. We found no evidence of publication bias affecting the results.CONCLUSION: Family doctors and clinicians should inform their patients about the increased risk of skin cancer associated with the use of CCB and β-blockers and instruct them to perform periodic skin self-examination. Further studies are warranted to elucidate the observed associations.

KW - Antihypertensive Agents/administration & dosage

KW - Humans

KW - Melanoma/chemically induced

KW - Skin Neoplasms/chemically induced

U2 - 10.1016/j.critrevonc.2017.12.003

DO - 10.1016/j.critrevonc.2017.12.003

M3 - Review article

C2 - 29458778

VL - 122

SP - 1

EP - 9

JO - Critical Reviews in Oncology/Hematology

JF - Critical Reviews in Oncology/Hematology

SN - 1040-8428

ER -