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Examining the influence of beta blockers and ACE inhibitors on the risk for breast cancer recurrence: results from the LACE cohort

  • Patricia A. GanzEmail author
  • Laurel A. Habel
  • Erin K. Weltzien
  • Bette J. Caan
  • Steven W. Cole
Epidemiology

Abstract

There is increasing interest in the relationship between host lifestyle factors and the outcomes of cancer treatment. Behavioral factors, comorbid conditions, and non-cancer-related pharmaceutical exposures may affect breast cancer (BC) outcomes. We used observational data from the LACE Study cohort (women with early stage BC from the Kaiser Permanente Northern California Cancer Registry) to examine the association between beta blockers (BBs) and/or angiotensin-converting enzyme inhibitors (ACEi) and BC recurrence, BC-specific mortality, and overall mortality. Among 1,779 women, there were 292 BC recurrences, 174 BC deaths, and 323 total deaths. 23% were exposed to either a BB and/or an ACEi. These drugs were associated with older age, postmenopausal status, tamoxifen therapy, greater pre-diagnosis BMI, hypertension, and diabetes. In Cox proportional hazards models, ACEi exposure was associated with BC recurrence (HR 1.56, 95% CI 1.02, 2.39, P = 0.04), but not cause-specific or overall mortality. Combined ACEi and BB were associated with overall mortality (HR 1.94, 95% CI 1.22, 3.10, P = 0.01). BB exposure was associated with lower hazard of recurrence and cause-specific mortality. However, there was no evidence of a dose response with either medication. For recurrence and cause-specific mortality, BB combined with ACEi was associated with a lower HR for the outcome than when ACEi alone was used. These hypothesis generating findings suggest that BC recurrence and survival were associated with exposure to two commonly used classes of anti-hypertensive medications. These observations need to be confirmed and suggest that greater attention should focus on the potential role of these commonly used medications in BC outcomes.

Keywords

Beta blockers ACE inhibitors Recurrence 

Notes

Acknowledgment

Funding source for the conduct of this research was provided to the following authors: Ganz (the Breast Cancer Research Foundation, the Jonsson Comprehensive Cancer Center Foundation, R01 CA109650), Habel (R01 CA98838 and R01 CA129059), Weltzien (R01 CA129059), Caan (R01 CA129059), and Cole (R01 CA116778).

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Patricia A. Ganz
    • 1
    • 4
    Email author
  • Laurel A. Habel
    • 2
  • Erin K. Weltzien
    • 2
  • Bette J. Caan
    • 2
  • Steven W. Cole
    • 3
  1. 1.UCLA Schools of Public Health and MedicineJonsson Comprehensive Cancer CenterLos AngelesUSA
  2. 2.Division of ResearchKaiser Permanente, Northern CaliforniaOaklandUSA
  3. 3.UCLA School of MedicineJonsson Comprehensive Cancer CenterLos AngelesUSA
  4. 4.Division of Cancer Prevention & Control ResearchJonsson Comprehensive Cancer CenterLos AngelesUSA

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