Use of Antihypertensive Medications and Risk of Adverse Breast Cancer Outcomes in a SEER–Medicare Population

Abstract

Background It is unclear if use of common antihypertensive medications influences the risk of adverse breast cancer outcomes. Methods Using the linked Surveillance, Epidemiology and End-Results (SEER)-Medicare database, we identified 14,766 women between ages 66 and 80 years diagnosed with incident stage I/II breast cancer between 2007–2011. Medicare Part D data were obtained to characterize women’s post-cancer use of various antihypertensive medications. Outcomes included a second breast cancer event (SBCE, a composite outcome defined as the first of a recurrence or a second contralateral primary breast cancer), breast cancer recurrence, and breast-cancer specific mortality. Time-varying Cox proportional hazard models were used to estimate hazard ratios (HRs) and their associated 95% confidence intervals (CIs). Results There were 791 SBCEs, 627 breast cancer recurrences, and 237 breast cancer deaths identified over a median follow-up of 3 years. Use of diuretics (n=8,517) after breast cancer diagnosis was associated with 29% (95% CI: 1.10–1.51), 36% (95% CI: 1.14–1.63) and 51% (95% CI: 1.11–2.04) higher risks of a SBCE, recurrence, and breast cancer death, respectively. Compared to nonusers, β-blockers users (n=7,145) had a 41% (95% CI: 1.07–1.84) higher risk of breast cancer death. Use of angiotensin II receptor blockers, calcium channel blockers and angiotensin-converting enzyme inhibitors were not associated with risks of breast cancer outcomes. Conclusions Use of diuretics and β-blockers may be associated with increased risk of breast cancer outcomes among older women. Impact Most antihypertensive medications are safe with respect to breast cancer outcomes, but more research is needed for diuretics and β-blockers.

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