Abstract
BackgroundThe antihypertensive agent hydrochlorothiazide has been associated with increased risks of non-melanoma skin cancer (NMSC) and possibly some melanoma subtypes. Previous studies were, however, conducted in predominantly Caucasian populations. We therefore examined the association between hydrochlorothiazide and skin cancer risk in an Asian population.MethodsBy using Taiwan’s National Health Insurance Research Database (NHIRD), we conducted three separate case–control studies of lip cancer, non-lip non-melanoma skin cancer and melanoma. Cases (n = 29,082) with a first-ever skin cancer diagnoses (2008–2015) were matched 1:10 to population controls. We estimated odds ratios (ORs) associating hydrochlorothiazide use with skin cancer risk by using conditional logistic regression.ResultsHydrochlorothiazide use showed no overall association with any of the three outcomes: ORs for high cumulative use of HCTZ (≥50,000 mg) were 0.86 (95% CI 0.09–7.81) for lip cancer, 1.16 (95% CI 0.98–1.37) for non-lip NMSC and 1.07 (95% CI 0.65–1.76) for melanoma. There was some evidence of a dose–response pattern for non-lip NMSC, with an OR of 1.66 (95% CI 0.82–3.33) for 100,000–149,999 mg of HCTZ. The null findings were robust across subgroup and sensitivity analyses.ConclusionUse of HCTZ appears safe in terms of skin cancer risk in an Asian population.
Highlights
The antihypertensive agent hydrochlorothiazide has been associated with increased risks of non-melanoma skin cancer (NMSC) and possibly some melanoma subtypes
Analyses were hindered by low numbers, with high-use of HCTZ returning a fully adjusted odds ratios (ORs) of 0.86 and dose–response analyses precluded due to the limited statistical power
While there was some evidence of an increased relative risk of non-lip NMSC with high cumulative use of HCTZ, these estimates were based on a low number of exposed cases
Summary
The antihypertensive agent hydrochlorothiazide has been associated with increased risks of non-melanoma skin cancer (NMSC) and possibly some melanoma subtypes. We examined the association between hydrochlorothiazide and skin cancer risk in an Asian population. RESULTS: Hydrochlorothiazide use showed no overall association with any of the three outcomes: ORs for high cumulative use of HCTZ (≥50,000 mg) were 0.86 (95% CI 0.09–7.81) for lip cancer, 1.16 (95% CI 0.98–1.37) for non-lip NMSC and 1.07 (95% CI 0.65–1.76) for melanoma. The antihypertensive agent hydrochlorothiazide (HCTZ) was recently found to be strongly associated with increased risks of squamous cell carcinoma (SCC) of the lip,[1,2] non-lip SCC of the skin[3] and more rare forms of non-melanoma skin cancer (NMSC).[4]. As previous studies have been carried out in predominantly Caucasian populations, it is unknown whether the risks associated with HCTZ use are generalisable to Asian populations, which have different skin phenotype[10] and a markedly lower baseline risk of skin cancer.[10,11] We used data from the nationwide Taiwanese health registries to examine the association between HCTZ use and the risk of skin cancer
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