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

Publication date: Available online 4 December 2017
Source:Journal of the American Academy of Dermatology
Author(s): Sidsel Arnspang, David Gaist, Sigrun Alba Johannesdottir Schmidt, Lisbet Rosenkrantz Hölmich, Søren Friis, Anton Pottegård
BackgroundHydrochlorothiazide, 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.ObjectiveTo examine the association between hydrochlorothiazide use and the risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).MethodsFrom the Danish Cancer Registry, we identified patients (cases) with NMSC during 2004-2012. Controls were matched 1:20 by age and sex. Cumulative hydrochlorothiazide use (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.ResultsHigh 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 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.LimitationsNo data on sun exposure was available.ConclusionsHydrochlorothiazide use is associated with a substantially increased risk of NMSC, especially SCC.