Could Widely Used Blood Pressure Meds Raise Skin Cancer Risk?
MONDAY, April 12, 2021 (HealthDay News) -- Most people are familiar with common sun-protection advice, from wearing and reapplying sunscreen to putting on a hat.
But a new Canadian study finds that for people who take certain blood pressure medications, that advice becomes even more critical because those drugs can increase their sensitivity to the sun's harmful ultraviolet (UV) rays.
The researchers reviewed data for nearly 303,000 adults in Ontario over 65 who were prescribed medications for high blood pressure. The study then compared their skin cancer histories with those of more then 605,000 adults who weren't taking antihypertensive drugs.
The findings showed that certain types of high blood pressure drugs — known as thiazide diuretics — were associated with higher rates of keratinocyte skin cancers, including basal cell carcinoma, squamous cell carcinoma, advanced keratinocyte carcinoma and melanoma.
"Our finding is not meant to rule out thiazide diuretics for patients," stressed study author Dr. Aaron Drucker. He's a clinical investigator in the dermatology department at Brown University's Alpert Medical School, in Providence, R.I.
"Overall, it's more a potential flag for someone who might be at increased risk of skin cancer, that has had one in the past or they have really fair skin and a lot of sun damage, that this might predispose them further to more skin cancer. Then, yes, someone like that might consider an alternative," Drucker said.
Four other blood pressure medications — angiotensin-converting enzyme (ACE) inhibitors, beta blockers, angiotensin II receptor blockers (ARBs) and calcium channel blockers — did not show an association with skin cancer risk.
"None of the other antihypertensive medications show the same signal, so in a way we have four negative controls," Drucker said.
Previous studies had shown increased risk of skin cancer among people taking the drug, also known as hydrochlorothiazide. This most common of the thiazide drugs earlier prompted warnings against prolonged use by Health Canada, the U.S. Food and Drug Administration and the European Medicines Agency, the study authors noted.
This new study followed people over time to determine if risk happened not just because a person took these medications, but whether the cumulative dose or duration might impact their skin cancer risk. Higher cumulative exposure (taking the medications over a longer period of time) was associated with increased rates of skin cancer, the findings showed.
"If you're on these medications for just a few years, it doesn't have a major impact on your cancer risk. But for someone who has been on, let's say, 25 milligrams a day of hydrochlorothiazide for 10 years, in our study that person would have a 40% increased risk of keratinocyte carcinoma," Drucker said. If they were on that same dose for 20 years, the increased relative risk compared to somebody who had not taken hydrochlorothiazide is a 75% increased risk, he added.
"So, there's a big effect of how much of it you've taken over how long that I think is really important to get across," Drucker explained.
UV radiation exposure is the most important environmental risk factor for skin cancer. Phototoxicity induced by medication can cause cellular damage to the skin, increasing the sun's carcinogenic potential, the study authors noted in the report published April 12 in the CMAJ.
Dr. John Strasswimmer is a Florida-based board-certified dermatologist and spokesperson for the Skin Cancer Foundation. He was not involved with the study, but commented on the findings.
"Skin cancer is a major increasing cancer in the United States," he said. "And, unfortunately, while we're getting better and better at treating them, just due to the sheer numbers of tumors, we're also having too many people still dying from skin cancers. And even those who don't die from it, it becomes a very big [health] problem for them. It really hurts their quality of life."
Strasswimmer said he hopes this study will encourage those using this common medication to practice good sun protection. There's no safe tan except perhaps a spray tan, he added. Any exposure that causes you to tan can also cause precancerous and cancerous changes to your skin.
He recommends stepping into the shade when you can. Cover your head. Wear good-quality UV clothing. And cover those other parts of your body with a good-quality sunscreen. Don't forget to reapply because it can break down, Strasswimmer said. People should also familiarize themselves with what skin cancer looks like.
"Skin cancer is an incredibly important disease to take care of," he noted. "However, it's not the only one." He pointed out that heart disease and high blood pressure are silent killers that cause a lot of death in the United States. "So, I think the last thing we would want to see would be people considering stopping their medications," Strasswimmer said.
"In this scenario, where people might be extra high risk for developing skin cancer or maybe have had a high risk for skin cancer, this could certainly prompt a conversation with their primary care doctor to find out if there might be an equivalent change that could be made," he suggested.
The U.S. National Cancer Institute has more information on skin cancer.
SOURCES: Aaron Drucker, MD, board-certified dermatologist and clinical investigator, department of dermatology, Brown University Alpert Medical School, Providence, R.I.; John Strasswimmer, MD, PhD, board-certified dermatologist, Delray Beach, Fla., spokesperson, Skin Cancer Foundation, and clinical professor, medicine/research professor of science, Florida Atlantic University, Boca Raton, Fla.; CMAJ (Canadian Medical Association Journal), April 12, 2021
Je, Dawa za Kudhibiti Shinikizo la Damu Zinazotumiwa sana Zinaweza Kuongeza Hatari ya Kansa ya Ngozi? JUJU, Aprili 12, 2021 (HealthDay News) - Watu wengi wanafahamu ushauri wa kawaida wa ulinzi wa jua, kutoka kuvaa na kutumia tena kinga ya jua hadi kuvaa kofia. Utafiti mpya wa Canada unaonyesha kuwa kwa watu wanaotumia dawa fulani za shinikizo la damu, ushauri huo unakuwa muhimu zaidi kwa sababu dawa hizo zinaweza kuongeza unyeti wao kwa miale ya jua yenye madhara. Watafiti hao walichunguza takwimu za watu wazima zaidi ya 303,000 huko Ontario ambao walikuwa wamepokea dawa za shinikizo la damu. Utafiti huo ulilinganisha historia ya saratani ya ngozi na ya watu wazima zaidi ya 605,000 ambao hawakuwa wakichukua dawa za kupunguza shinikizo la damu. Utafiti huo ulionyesha kuwa aina fulani za dawa za shinikizo la damu - zinazojulikana kama thiazide diuretics - zilihusishwa na viwango vya juu vya saratani za ngozi za keratinocyte, ikiwa ni pamoja na kansa ya seli ya msingi, kansa ya seli ya squamous, kansa ya keratinocyte ya hali ya juu na melanoma. "Ugunduzi wetu haukusudiwi kuondoa dawa za kuondoa umajimaji za thiazide kwa wagonjwa", akasisitiza mwandishi wa utafiti Dakt. Aaron Drucker. "Mwanamke huyo ambaye ni mtafiti wa kliniki katika idara ya dermatolojia katika Chuo Kikuu cha Brown, Alpert Medical School, Providence, R.I., alisema: ""Kwa ujumla, ni ishara ya uwezekano kwa mtu ambaye anaweza kuwa na hatari ya kuongezeka kwa kansa ya ngozi, ambaye amekuwa na moja katika siku za nyuma au ana ngozi ya wazi na uharibifu mwingi wa jua, kwamba hii inaweza kuwafanya kuwa na kansa ya ngozi zaidi." Kisha, ndiyo, mtu kama huyo anaweza kufikiria mbadala", Drucker alisema. Dawa nyingine nne za shinikizo la damu - angiotensin-converting enzyme (ACE) inhibitors, beta blockers, angiotensin II receptor blockers (ARBs) na calcium channel blockers - hazikuonyesha uhusiano na hatari ya kansa ya ngozi. "Hakuna dawa nyingine za kupunguza shinikizo la damu zinazoonyesha ishara hiyohiyo, kwa hiyo kwa njia fulani tuna udhibiti nne mbaya", Drucker akasema. Utafiti wa hivi karibuni umeonyesha kuwa kuna uwezekano mkubwa wa kansa ya ngozi kwa watu wanaotumia dawa hiyo inayoitwa hydrochlorothiazide. "Hii ni dawa ya kawaida ya thiazide ambayo ilisababisha maonyo dhidi ya matumizi ya muda mrefu na ""Health Canada,"" ""Usimamizi wa Chakula na Dawa wa Marekani"" na ""Wakala wa Dawa za Ulaya.""" Utafiti huu mpya ulifuatilia watu kwa muda ili kuamua ikiwa hatari ilitokea sio kwa sababu mtu alichukua dawa hizi, lakini ikiwa kipimo cha jumla au muda wa muda ungeweza kuathiri hatari yao ya saratani ya ngozi. Uwezo wa kuongeza matumizi ya dawa kwa muda mrefu zaidi ulihusishwa na ongezeko la saratani ya ngozi. "Ikiwa unatumia dawa hizi kwa miaka michache tu, haikuwa na athari kubwa kwa hatari yako ya kansa. """ "Kwa mtu ambaye amekuwa akichukua, hebu tuseme, miligram 25 kwa siku ya hydrochlorothiazide kwa miaka 10, katika utafiti wetu mtu huyo angekuwa na hatari ya 40% ya kuongezeka kwa keratinocyte carcinoma. """ "Wakati wa kutumia dawa hiyo kwa miaka 20, hatari ya kuongezeka ikilinganishwa na mtu ambaye hakuwa amechukua hydrochlorothiazide ni ""hatari ya kuongezeka kwa 75%.""" "Kwa hivyo, kuna athari kubwa ya kiasi gani umechukua juu ya muda gani ambao nadhani ni muhimu sana kuwasiliana, "Drucker alielezea. Mwangaza wa miale ya UV ni sababu muhimu zaidi ya mazingira ya hatari ya kansa ya ngozi. "Kutokana na athari za dawa za kulevya, "" phototoxicity "" inaweza kusababisha uharibifu wa seli za ngozi, na kuongeza uwezekano wa kansa ya jua, waandishi wa utafiti walibainisha katika ripoti iliyochapishwa Aprili 12 katika CMAJ." Dr. John Strasswimmer ni daktari wa ngozi mwenye vyeti vya bodi na msemaji wa Shirika la Saratani ya Ngozi. Yeye hakuwa na kushiriki katika utafiti, lakini alitoa maoni juu ya matokeo. "Kansa ya ngozi ni kansa kubwa inayoongezeka katika Marekani", akasema. "Na, kwa bahati mbaya, wakati sisi ni kupata bora na bora katika kuwatibu, tu kutokana na idadi kubwa ya uvimbe, sisi pia kuwa na watu wengi sana bado kufa kutokana na kansa ya ngozi. """ Na hata wale ambao hawafi kutokana nayo, inakuwa tatizo kubwa sana la [afya] kwao. Hilo huharibu sana hali yao ya maisha". Strasswimmer alisema anatumaini utafiti huu utawatia moyo wale wanaotumia dawa hii ya kawaida kufanya mazoezi mazuri ya kujilinda kutoka kwa jua. Hakuna tan salama isipokuwa labda spray tan, aliongeza. Madhara yoyote ambayo yanaweza kusababisha tan inaweza pia kusababisha mabadiliko ya precancerous na kansa kwenye ngozi yako. Anapendekeza uingie katika kivuli unapopata nafasi. Funika kichwa chako. Vaa mavazi yenye ubora wa hali ya juu. Na kufunika sehemu nyingine za mwili wako na kinga ya jua ya ubora. Usisahau kuomba tena kwa sababu inaweza kuvunjika, Strasswimmer alisema. Watu wanapaswa pia kujijua kansa ya ngozi inaonekanaje. "Kansa ya ngozi ni ugonjwa muhimu sana wa kutibiwa", akasema. "Hata hivyo, si ile pekee". "Mwanamke huyo alisema: ""Ugonjwa wa moyo na shinikizo la damu ni wauaji wa kimya ambao husababisha vifo vingi nchini Marekani." "Kwa hiyo, nadhani jambo la mwisho tunalotaka kuona ni watu wakifikiria kuacha kutumia dawa zao", Strasswimmer akasema. "Katika hali hii, ambapo watu wanaweza kuwa na hatari kubwa ya kuendeleza kansa ya ngozi au labda wamekuwa na hatari kubwa ya kansa ya ngozi, hii inaweza hakika kuchochea mazungumzo na daktari wao wa huduma ya msingi ili kujua kama kunaweza kuwa na mabadiliko sawa ambayo yanaweza kufanywa. """ Taasisi ya Kitaifa ya Saratani ya Marekani ina habari zaidi kuhusu kansa ya ngozi. Aaron Drucker, MD, Daktari wa ngozi na mtafiti wa kliniki, Idara ya Daktari wa ngozi, Chuo Kikuu cha Brown, Alpert Medical School, Providence, R.I., John Strasswimmer, MD, PhD, Daktari wa ngozi na daktari, Delray Beach, FL, msemaji, Shirika la Saratani ya Ngozi, na profesa wa kliniki, Daktari, Profesa wa Sayansi ya Utafiti, Chuo Kikuu cha Florida Atlantic, Boca Raton, FL, Jari CMAJ (Chama cha Tiba cha Canada), Aprili 12, 2021.