Advertisement

Patients Taking Antihypertensive Drugs Show Increase in Lip Cancer

Summary and Comment |
August 30, 2012

Patients Taking Antihypertensive Drugs Show Increase in Lip Cancer

  1. Craig A. Elmets, MD

Hydrochlorothiazide, HCTZ-triamterene, and nifedipine were associated with a higher incidence of lip cancer.

  1. Craig A. Elmets, MD

Cancer of the lip (i.e., of the vermillion border, commissure, and labial mucosa) is a rare malignancy (yearly incidence in the U.S., 0.7/100,000 persons). Usually occurring on the lower lip, this cancer is much less common in the dark-skinned, suggesting that sun exposure is a major causative factor. Prompted by epidemiologic studies that linked some antihypertensive medications with cutaneous squamous cell carcinomas (SCCs; presumably through photosensitization), investigators looked for an association with lip cancer as well.

They reviewed more than 13 years of pharmacy records from a large HMO and identified 712 cases of lip cancer among non-Hispanic whites who were not HIV-positive or organ transplant recipients at diagnosis. They compared these cases with 22,904 matched controls without lip cancer. The hypertension drugs hydrochlorothiazide (HCTZ), HCTZ-triamterene, and nifedipine were associated with a higher incidence of lip cancer; the relative risk for HCTZ users was 2.2 (odds ratio, 1.76–2.79). As expected, lip cancer was also associated with smoking, but the higher risk in HCTZ, HCTZ-triamterene, and nifedipine users remained after multivariable analysis. Lisinopril recipients had no increased lip cancer incidence, indicating that risk was drug related rather than hypertension related. The likelihood of developing lip cancer correlated positively with duration of treatment with these drugs. Those with at least 5 years of HCTZ treatment had a fourfold increase in lip cancer.

Comment

Hydrochlorothiazide has been implicated as a risk factor for cutaneous SCCs; these findings add evidence that long-term treatment raises risks for epithelial neoplasms. Though it is plausible that the photosensitizing properties of HCTZ and nifedipine are responsible for the increased risk, such a mechanism cannot be proven by the available information here. However, long-term users of nifedipine and HCTZ medications should employ broad-spectrum sunscreens that block out both ultraviolet A and B and should be monitored carefully for skin and lip cancers.

Citation(s):

Reader Comments (4)

Rabia.A. Vali

one has to really consider the thought of initiating treatment in pts and to inform about the consequences.would definately like to know at what dose and who will be affected more

Competing interests: None declared

Richard R Thornton, M.D.

It would be helpful to know if the authors designated a dose of the drug HCTZ in selecting patients. Also giving the brand names for each antihypertensive would be helpful

Competing interests: None declared

Zvonko Rumboldt

It would be important indeed to compare chlorthalidone with HCTZ! Have you any data?

Competing interests: None declared

Sandeep Saluja

Would chlorthalidone be expected to have similar properties.If not,that would be another reason to shift from HCTZ to chlorthalidone. Further,if sun screens are to be routinely used,this would offset any cost advantage that HCTZ or nifedipine may offer.

Competing interests: None declared

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

Advertisement
Advertisement
Advertisement