Relation of statin use with non-melanoma skin cancer: prospective results from the Women's Health Initiative

Statins Inhibit Cutaneous Squamous Cell Carcinoma Cells

Abstract is missing (Short communication)

Photosensibilisierende Antihypertensiva und das Hautkrebsrisiko bei postmenopausalen Frauen: Photosensitizing antihypertensive medication and risk of skin cancer among postmenopausal women

Hintergrund

Es gibt nur wenige prospektive Studien, die die Dosis‐Wirkungs‐Beziehung zwischen der Anwendung einiger photosensibilisierender Antihypertensiva und Hautkrebs untersucht haben.

Patienten und Methodik

Anhand prospektiver Daten aus der Women's Health Initiative Observational Study untersuchten wir den Zusammenhang zwischen der Anwendung von Antihypertensiva und dem Risiko für nicht melanozytären Hautkrebs (NMSC) und dem Melanom bei postmenopausalen Frauen im Alter von 50–79 Jahren (n = 64 918). Dabei wurden multivariable Cox‐Regressionsmodelle (Proportional‐Hazard‐Modelle) verwendet und Hazard Ratios (HR) sowie 95%‐Konfidenzintervalle (KI) berechnet.

Ergebnisse

8777 NMSC und 1227 Melanom‐Fälle wurden beobachtet. Die Anwendung von Antihypertensiva (HR [95%‐KI]: 1,12 [1,07–1,18]), ACE‐Hemmern (1,09 [1,01–1,18]), Kalziumkanalblockern (1,13 [1,05–1,22]), Diuretika (1,20 [1,12–1,27]), Schleifendiuretika (1,17 [1,07–1,28]) und Thiaziden (1,17 [1,03–1,33]) war jeweils mit einem erhöhten NMSC‐Risiko assoziiert. Das NMSC‐Risiko stieg linear mit der Anwendung mehrerer Antihypertensiva (p‐Trend = 0,02) und mit zunehmender Anwendungsdauer (p‐Trend < 0,01) an. Antihypertensiva (1,15 [1,00–1,31]), Angiotensin‐II‐Rezeptorblocker (1,82 [1,05–3,15]) und Diuretika (1,34 [1,13–1,59]) waren jeweils mit einem erhöhten Melanomrisiko assoziiert. Zwischen der Anwendung von Antihypertensiva und der Melanom‐Inzidenz wurde eine Effektmodifikation durch Exposition gegenüber Sonnenlicht‐Exposition beobachtet (p‐Interaktion = 0,02).

Schlussfolgerungen

Die Anwendung von Antihypertensiva allgemein und einiger einzelner Klassen von Antihypertensiva ging mit einer erhöhten Inzidenz von NMSC und Melanomen einher, wobei eine Dosis‐Wirkungs‐Beziehung bestand.

Photosensitizing antihypertensive medication and risk of skin cancer among postmenopausal women

BACKGROUND

Few prospective studies exist with an evaluation of a dose-response relationship between use of some photosensitizing antihypertensive medications and skin cancer.

PATIENT AND METHODS

We used prospective data from the Women's Health Initiative Observational Study to investigate the association between antihypertensive use and risk of non-melanoma skin cancer (NMSC) and melanoma in postmenopausal women aged 50-79 years at baseline (n  =  64,918). Multivariable Cox proportional hazards regression models were used and hazard ratios (HRs) and 95 confidence intervals (CIs) were calculated.

RESULTS

8,777 NMSC and 1,227 melanoma cases were observed. Use of antihypertensives (HR [95% CI]: 1.12 [1.07-1.18]), ACE inhibitors (1.09 [1.01-1.18]), calcium channel blockers (1.13 [1.05-1.22]), diuretics (1.20 [1.12-1.27]), loop diuretics (1.17 [1.07-1.28]), and thiazides (1.17 [1.03-1.33]) were each associated with higher NMSC risk. NMSC risk linearly increased with use of multiple antihypertensives (p-trend  =  0.02) and with longer duration of use (p-trend < 0.01). Antihypertensives (1.15 [1.00-1.31]), angiotensin-II receptor blockers (1.82 [1.05-3.15]), and diuretics (1.34 [1.13-1.59]) were each associated with elevated melanoma risk. Effect modification by solar radiation exposure was found between antihypertensive use and incidence of melanoma (p-interaction  =  0.02).

CONCLUSIONS

Use of antihypertensives overall, and several individual classes thereof, were associated with higher incidence of NMSC and melanoma with dose-response relationship.

Association between statins exposure and risk of skin cancer: an updated meta-analysis

This study aimed to investigate the relationship between statin (lipophilic statin and hydrophilic statin) exposure and the risk of skin cancer. The incidence of skin cancer under statin exposure was used as the primary outcome, and the relevant studies were screened from Web of Science, PubMed, Cochrane Library, and EBSCO electronic database until September 2022. Ten observational studies and two randomized controlled trials (RCTs) were included. The statistical results indicated that in lipophilic statins, the exposed group had a higher risk of skin cancer than the non-exposed group (OR: 1.09, P = 0.003). However, compared with the non-exposed group, there was no significant difference between hydrophilic statins exposure and the incidence of skin cancer (OR: 1.02, P = 0.341). Further subgroup analysis of the subtypes of statins revealed that compared with the non-exposed group, exposure to lovastatin (OR: 1.18, P = 0.048) or simvastatin (OR: 1.11, P < 0.001) was a risk factor for skin cancer. Besides, subgroup analysis based on the subtypes of skin cancer demonstrated that the risks of melanoma (OR: 1.13, P = 0.009), basal cell carcinoma (BCC) (OR: 1.05, P = 0.036), and squamous cell carcinoma (SCC) (OR: 1.13, P = 0.026) under lipophilic statin exposure were significantly higher than those in the non-exposed group. On the contrary, compared with the non-exposed group, the risk of BCC was significantly reduced under the exposure of hydrophilic statins (OR: 0.93, P = 0.031). This study showed that the relationship between statin exposure and skin cancer risk was affected by the subtypes of statins and skin cancer subtypes.

Investigating the burden of cardiovascular comorbidities in inpatient non-melanoma skin cancer outcomes

While cardiovascular comorbidities can affect the outcomes of a variety of conditions, to our knowledge, few studies have evaluated their impact on non-melanoma skin cancers (NMSC). We studied the National Inpatient Sample to evaluate the impact of cardiovascular comorbidities on NMSC hospitalizations. Our findings displayed higher cost of care (Beta 5053; SE 1150; P < 0.001), length of stay (Beta 1.8; SE 0.394; P < 0.001), and mortality (aOR 2.51; CI 1.49-4.21; P < 0.001) in patients with NMSC who had an associated cardiovascular comorbidity. Specifically, patients with cerebrovascular disease (aOR 3.52; CI 1.18-10.5; P = 0.024), heart failure (aOR 4.02; CI 2.29-7.05; P < 0.001), complicated hypertension (OR 2.05; CI 1.16-3.61; P = 0.013), and pulmonary circulation disease (aOR 3.33; CI 1.13-9.78; P = 0.029) demonstrated greater odds of mortality.

Statin Use and Skin Cancer Risk: A Prospective Cohort Study

Epidemiological studies on statin use in relation to skin cancer risk are scarce and yielded conflicting results. We explored this association in Etude Epidémiologique auprès de femmes de l'Education Nationale, a prospective cohort of French women born in 1925-1950. Health and lifestyle data were self-reported biennially and matched with drug reimbursement data, allowing the identification of participants' statin use since 2004. Multivariable cause-specific hazards regression models adjusted for skin cancer risk factors estimated hazard ratios with 95% confidence intervals. Over 2004-2014, 455 cutaneous melanoma, 1,741 basal cell carcinoma, and 268 squamous cell carcinoma cases were ascertained among 62,473 women. Compared with never use, there were no associations between ever use of statins and melanoma (hazard ratio = 1.16, 95% confidence interval = 0.94-1.44) or squamous cell carcinoma (hazard ratio = 0.89, 95% confidence interval = 0.66-1.19) risks and a decrease in basal cell carcinoma risk with ever use of statins (hazard ratio = 0.89, 95% confidence interval = 0.79-0.996). We found no trend of increasing or decreasing risks with dose, duration of use, time since first use, or age at first use and no statistically significant effect modification by pigmentary traits or residential UVR exposure. Because of the limited number of studies evaluating the associations between the use of statins and the risks of melanoma, basal cell carcinoma, and squamous cell carcinoma, these findings would deserve further investigation in other settings.

Regression of Periocular Basal Cell Carcinoma: A Report of Four Cases with Clinicopathologic Correlation

Objectives

To describe the spectrum of clinical and histopathological features of a case series of basal cell carcinoma (BCC) with spontaneous regression and to discuss this phenomenon.

Method

Four cases of BCC with complete/substantial regression were retrospectively identified. Patients' records were analyzed for demographic data, clinical appearance, and the postoperative course. Formalin-fixed, paraffin-embedded specimens were routinely processed and stained with hematoxylin and eosin and periodic acid Schiff.

Results

Complete (n = 1) or partial (n = 3) regression of BCC was observed in 4 patients. Two lesions at the medial canthus were histologically diagnosed as nodular BCC with significant regression. One lesion at the lower eyelid exhibited a complete regression which did not require surgical intervention. The other lesion at the lower eyelid presenting with ulceration and madarosis was excised. Scar tissue without evidence for a neoplasm was present histologically. Subsequently, the patient developed a recurrence with a histologically proven micronodular BCC.

Conclusions

BCC can show spontaneous substantial or complete regression. Histological tumor absence in lesions which are clinically suspicious for a neoplasm can be a hint for a regressive BCC. Recurrences may develop from remaining tumor islands warranting periodical clinical visits in cases of clinically as well as histologically suspected regressive BCC.

Statin use and risk of skin cancer

BACKGROUND

Statins are among the most commonly used medications in the United States, and statin use is associated with increased risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). However, previous studies are limited by lack of adjustment for important confounders.

OBJECTIVE

Examine the relation between statins and skin cancer risk in the Nurses' Health Study and Health Professionals Follow-up Study.

METHODS

Cox proportional hazards regression was used to evaluate associations.

RESULTS

During follow-up (2000-2010), we documented 10,201 BCC, 1393 SCC, and 333 melanoma cases. History of high cholesterol level was not associated with risk of BCC (pooled multivariable-adjusted hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.00-1.09), SCC (HR, 0.95; 95% CI, 0.85-1.06), or melanoma (HR, 0.87; 95% CI, 0.64-1.19). Statin use was not associated with risk of BCC (HR, 1.04; 95% CI, 0.99-1.09]), SCC (HR, 1.08; 95% CI, 0.94-1.24), or melanoma (HR, 1.04; 95% CI, 0.78-1.38). There was a trend toward higher BCC risk with longer duration of statin use in men (P trend = .003) but not in women (P trend = .86).

LIMITATIONS

Lack of treatment data.

CONCLUSION

History of high cholesterol level was not associated with skin cancer risk. Longer duration of statin use was associated with a trend toward higher BCC risk in men.

Marketed drugs used for the management of hypercholesterolemia as anticancer armament

The design of novel pharmacologic agents as well as their approval for sale in markets all over the world is a tedious and pricey process. Inevitably, oncologic patients commonly experience unwanted effects of new anticancer drugs, while the acquisition of clinical experience for these drugs is largely based on doctor–patient partnership which is not always effective. The repositioning of marketed non-antineoplastic drugs that hopefully exhibit anticancer properties into the field of oncology is a challenging option that gains ground and attracts preclinical and clinical research in an effort to override all these hindrances and minimize the risk for reduced efficacy and/or personalized toxicity. This review aims to present the anticancer properties of drugs used for the management of hypercholesterolemia. A global view of the antitumorigenicity of all marketed antihypercholesterolemic drugs is of major importance, given that atherosclerosis, which is etiologically linked to hypercholesterolemia, is a leading worldwide cause of morbidity and mortality, while hypercholesterolemia and tumorigenesis are known to be interrelated. In vitro, in vivo and clinical literature data accumulated so far outline the mechanistic basis of the antitumor function of these agents and how they could find application at the clinical setting.

Protective Effects of Statins in Cancer: Should They Be Prescribed for High-Risk Patients?

PURPOSE OF REVIEW

Statins are one of the most widely prescribed drug classes in the USA. This review aims to summarize recent research on the relationship between statin use and cancer outcomes, in the context of clinical guidelines for statin use in patients with cancer or who are at high risk for cancer.

RECENT FINDINGS

A growing body of research has investigated the relationship between statins and cancer with mixed results. Cancer incidence has been more extensively studied than cancer survival, though results are inconsistent as some large meta-analyses have not found an association, while other studies have reported improved cancer outcomes with the use of statins. Additionally, two large studies reported increased all-cancer survival with statin use. Studies on specific cancer types in relation to cancer use have also been mixed, though the most promising results appear to be found in gastrointestinal cancers. Few studies have reported an increased risk of cancer incidence or decreased survival with statin use, though this type of association has been more commonly reported for cutaneous cancers. The overall literature on statins in relation to cancer incidence and survival is mixed, and additional research is warranted before any changes in clinical guidelines can be recommended. Future research areas include randomized controlled trials, studies on specific cancer types in relation to statin use, studies on populations without clinical indication for statins, elucidation of underlying biological mechanisms, and investigation of different statin types. However, studies seem to suggest that statins may be protective and are not likely to be harmful in the setting of cancer, suggesting that cancer patients who already take statins should not have this medication discontinued.

Statin use and non-melanoma skin cancer risk: a meta-analysis of randomized controlled trials and observational studies

BACKGROUND

Existing evidence of the association between statin use and non-melanoma skin cancer (NMSC) risk has been inconsistent.

OBJECTIVE

To maximize statistical power to synthesize prospective evidence on this relationship.

MATERIALS AND METHODS

PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrial.gov were systematically searched up to December 11, 2016. A random-effects meta-analysis was conducted to calculate summary estimates.

RESULTS

Our meta-analysis of 14 randomized controlled trials (RCTs) including 63,157 subjects showed no significant association between statin use and NMSC risk (RR = 1.09, 95%CI = 0.85-1.39). However, meta-analysis of four observational studies including 1,528,215 participants showed significantly increased risk of NMSC among statin users compared to non-users (RR = 1.11, 95%CI = 1.02-1.22). Furthermore, ever using lipophilic statins (RR = 1.14, 95%CI = 1.04-1.24) or lower-potency statins (RR = 1.14, 95%CI = 1.03-1.26), as well as usage of any statin longer than one year (RR = 1.14, 95%CI = 1.09-1.18) were significantly associated with increased NMSC risk based on observational studies.

CONCLUSIONS

Evidence from observational studies supported an association between statin use and increased NMSC risk. This finding should be interpreted with caution due to modest number of included studies, possible between-study heterogeneity and inherent limitations of observational studies.

Polypharmacy and sun exposure: Implications for mitochondrial DNA deletions in skin

Most somatic cells contain many copies of mitochondrial DNA (mtDNA). Because of both the high copy number and the lack of repair mechanisms available to mtDNA, damage to it largely goes unrepaired, and can accumulate over time. Large scale deletions are a recognised type of damage sustained by mtDNA as a consequence of exposure to the ultraviolet light in sunlight. A group of patients were identified as having abnormally high levels of either a 4977 base pair deletion (mtDNA⁴⁹⁷⁷) or 3895 base pair deletion (mtDNA³⁸⁹⁵), in mtDNA from sun exposed skin or skin suspected to be a non-melanoma skin cancer, but not in their non-sun exposed skin biopsies. In three of the four cases, skin cancer was ruled out due to histological testing. Additional factors from these patients' medical histories were studied, and it was noted that they shared diagnoses for multiple pathologies common to an older population, and that they were being treated with the same or related pharmaceuticals, including some that had been known to cause dermal side effects. Investigation into the biochemistry underlying the symptoms, the effects of sun exposure and side effects of the prescribed pharmaceuticals revealed a possible synergistic relationship leading to the localised high levels of mtDNA deletions.