05 Jan Hydrochlorothiazide and risk of non-melanoma skin cancer – critical appraisal (Q18-05)
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Hydrochlorothiazide and risk of non-melanoma skin cancer – critical appraisal (Q18-05)
Q18-05
Overview
What is the issue?
- Thiazide diuretics (particularly hydrochlorothiazide) were recently linked to an increased risk of skin cancer. Given the widespread use of thiazide diuretics, a potential skin cancer promoting effect would be an important health concern.
What was the aim of the syudy?
- To critically appraise in a narrative review, the association between the use of thiazide and thiazide-like diuretics and risk of skin cancer.
How was the study conducted?
- The chemical structures and photosynthesizing potential of selected thiazide and thiazide-like diuretics were evaluated.
- A search in PubMed (up to December 2018) for all published observational studies assessing the association between the use of thiazide or thiazide-like diuretics and the risk of skin cancer was completed.
- Studies were reviewed and quality was assessed for major methodological biases.
What did the study find?
- Commonly used thiazide and thiazide-like diuretics carry resonating structural components, such as sulfonamide groups, that contribute to their photosensitizing activity.
- Overall, 13 observational (9 case-control, 4 cohort) studies assessed the association between the use of different thiazide or thiazide-like diuretics and risk of several skin cancer types.
- Nine of the 13 studies showed positive associations ranging from 3% increased risk for bendroflumethiazide and basal cell carcinoma to 311% increased risk for thiazide diuretics and squamous cell carcinoma.
- All studies had important design-related methodological limitations including potential confounding by indication, detection bias, and time-window bias.
Implications
- Well-designed observational studies are needed to provide more solid evidence on the possible association between the use of thiazide and thiazide-like diuretics and skin cancer.
Key messages
- Commonly used thiazide and thiazide-like diuretics have photosensitizing potential, and several observational studies, have linked their use to an increased risk of skin cancer, although with important methodological limitations.
Manuscripts
Kreutz R, Algharably EAH, Douros A. Reviewing the effects of thiazide and thiazide-like diuretics as photosensitizing drugs on the risk of skin cancer. J Hypertens. 2019 Oct;37(10):1950-1958.