High-ceiling diuretics are associated with an increased risk of basal cell carcinoma in a population-based follow-up study |
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| Authors: | Rikje Ruiter Loes E. Visser Mark Eijgelsheim Eline M. Rodenburg Albert Hofman Jan-Willem W. Coebergh Tamar Nijsten Bruno H.Ch. Stricker |
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| Affiliation: | 1. Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands;2. Drug Safety Unit, Inspectorate for Health Care, The Hague, The Netherlands;3. Department of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands;4. Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands;5. Department of Public Health, Erasmus MC, Rotterdam, The Netherlands;6. Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands;7. Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands;1. Molecular Imaging Department, Harley Street Clinic, London, United Kingdom;2. Division of Clinical and Laboratory Investigation, Brighton and Sussex Medical School, Brighton, United Kingdom;3. Cardiovascular and Cell Sciences Research Institute, St George''s, University of London, London, United Kingdom;1. Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada;2. Research Centre, CHU Sainte-Justine, Montreal, QC, Canada;3. Norman and Helen Asher Professor of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;4. Pharmakovigilanz-und Beratungszentrum für Embryonaltoxikologie, Berlin Institute for Clinical, Teratology and Drug Risk Assessment in Pregnancy, Charité?Universitätsmedizin, Berlin, Germany;5. Department of Pediatrics, Division of Dysmorphology and Teratology, University of California San Diego, La Jolla, CA, USA;1. Department of Internal Medicine, Wexner Medical Center at The Ohio State University, Columbus, Ohio;2. Department of Pediatrics, Nationwide Children''s Hospital, Columbus, Ohio;3. Department of Dermatology and Cutaneous Biology, Thomas Jefferson University Hospital, Philadelphia, Pa;4. St. Mary Medical Center, Langhorne, Pa;1. Department of Neurology, Odense University Hospital, Odense, Denmark;2. Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark;3. Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark;4. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark;5. Department of Plastic Surgery, Herlev-Gentofte Hospital, Herlev, Denmark;6. Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark;7. Department of Public Health, University of Copenhagen, Copenhagen, Denmark;1. Department of Neurology, Odense University Hospital, Odense, Denmark;2. Department of Clinical Research, Faculty of Health Sciences, Odense, Denmark;3. Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark;4. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark;5. Department of Plastic Surgery, Herlev-Gentofte Hospital, Herlev, Denmark;6. Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark;7. Department of Public Health, University of Copenhagen, Copenhagen, Denmark |
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| Abstract: | IntroductionIn Caucasians, basal cell carcinoma (BCC) is among the most frequently diagnosed cancers and its incidence is increasing. Known risk factors for the development of BCC are age, sun exposure, and certain skin characteristics. Despite photosensitizing abilities of diuretic agents, little is known about a possible association with BCC.MethodsData were obtained from the Rotterdam Study; a large prospective population-based follow-up study with coverage of prescription-only drugs from pharmacies. The diagnoses of BCC were obtained through general practitioners, and by linkage with a registry of histo- and cytopathology. Cumulative use of diuretics at the date of diagnosis was categorized into quartiles for users of high-ceiling diuretics, potassium sparing agents and thiazides. The association between these drugs and BCC was assessed by Cox proportional hazard modeling with adjustment for age, gender and potential confounders. Effect modification was tested with interaction terms.ResultsUse of high-ceiling diuretics in the highest quartile (>3.7 years cumulative exposure) was associated with an increased hazard of BCC of 62% compared to no use (HR 1.6; 95% CI 1.1–2.4). Patients who used high-ceiling diuretics and had a high tendency of getting sunburned had a higher risk of diagnosis than non-users who do not easily get sunburned. Neither the use of potassium sparing agents, nor the use of thiazides was associated with BCC.ConclusionIn our study, cumulative use of high-ceiling diuretics was associated with an increased risk of diagnosis of BCC. This effect is stronger in patients who easily get sunburned. |
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