(G) Thiazide Diuretics and The Risk of Skin Cancer: A Meta-Analysis of Observational Studies

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall E South

Publication Number: 297

Presenting Author(s)

Tien Hoang Tran
– University Medical Center at Ho chi minh city, National Cancer Center Graduate School of Cancer Science and Policy, Ho Chi Minh City, Vietnam

Co-Author(s)

Seung-Kwon Myung
– Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea, Republic of Korea
Thao Thi Kim Trinh
– Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea, Vietnam

Background: Several thiazide drugs are photosensitizing and may thus act as co-carcinogens with ultraviolet light to increase the risk of skin cancer. Although several observational epidemiological studies have investigated the link between the use of thiazides and skin cancers, those findings remain conflicting and controversial.

Objectives: To assess whether thiazide diuretic use is associated with the risk of skin cancer by using a meta-analysis of observational studies.

Methods: We searched PubMed and EMBASE to locate eligible studies in November 2021. The keywords for the literature search were as follows: “thiazide diuretics” and “skin cancer”. We included observational studies such as case-control studies or cohort studies reporting odds ratios (OR) and relative risks (RR) with 95% confidence intervals (CI). If data were duplicated or shared in more than one study, the most comprehensive study was included in the final analysis. The language of publication was restricted to English. Two investigators independently extracted the characteristics and results of identified studies and performed standardized quality ratings. We calculated pooled ORs or RRs and 95% CIs with a random-effects model. We used the Stata SE version 16.0 software package (StataCorp, College Station, Texas, USA) for statistical analysis.

Results: We included 23 observational studies with 13 case-control studies and 10 cohort studies in the final analysis. In the random-effects model meta-analysis of all studies, the use of thiazide diuretic was associated with an increased risk of skin cancer (OR or RR 1.18, 95% CI 1.10 to 1.26; I2 = 92.5%). In the subgroup meta-analysis by type of study, thiazide diuretics also increased the risk of skin cancer in both case-control studies (OR 1.18, 95% CI 1.10 to 1.28; I2 = 86.8%; n =13) and cohort studies (RR 1.16, 95% CI 1.05 to 1.28; I2 = 92.2%; n = 10). The subgroup meta-analyses by geographic region showed that thiazide diuretics use was associated with an increased risk of skin cancer in America (OR or RR 1.28; 95% CI 1.05 to 1.56; I2 = 86.3%; n = 4) and Europe (OR or RR 1.19; 95% CI 1.10 to 1.29; I2 = 94.2%; n = 14), but not in Asia (OR or RR 1.01; 95% CI 0.89 to 1.15; I2 = 45.2%; n = 4).

Conclusions: The current meta-analysis of observational studies found that the use of thiazide diuretics increased the risk of skin cancer. Especially, cohort studies with a higher level of evidence consistently indicated this association. However, the Asian population may not be at increased risk of skin cancer when using thiazide diuretics. Our findings should not be interpreted that patients should discontinue using thiazide diuretics. Physicians should recommend their patients take protective skincare measures to reduce the risk of skin cancer.