TY - JOUR
T1 - Propranolol and survival from breast cancer
T2 - A pooled analysis of European breast cancer cohorts
AU - Cardwell, Chris R.
AU - Pottegård, Anton
AU - Vaes, Evelien
AU - Garmo, Hans
AU - Murray, Liam J.
AU - Brown, Chris
AU - Vissers, Pauline A.J.
AU - O'Rorke, Michael
AU - Visvanathan, Kala
AU - Cronin-Fenton, Deirdre
AU - De Schutter, Harlinde
AU - Lambe, Mats
AU - Powe, Des G.
AU - Herk-Sukel, Myrthe P.P.van
AU - Gavin, Anna
AU - Friis, Søren
AU - Sharp, Linda
AU - Bennett, Kathleen
N1 - Funding Information:
The English cohort is based in part on data from the General Practice Research Database obtained under licence from the UK Medicines and Healthcare Regulatory Agency. However, the interpretation and conclusions contained in study are those of the authors alone. Morten Olesen is acknowledged for help with the data management of the Danish cohort. The Belgian cohort is based upon data from the Belgian Cancer Registry (BCR), the Belgian health insurance companies, provided by the Belgian Intermutualistic Agency (IMA), and the Belgian Crossroads bank for Social Security (BCSS), and the authors would like to acknowledge everyone from the BCR, IMA and BCSS who made this work possible. Thanks to Úna McMenamin, and the staff of the Northern Ireland Cancer Registry who assisted in the collection of the Northern Ireland cohort. The authors would like to thank the research coordinators (Lizzie Nicholson and David Bailey) and NHS National Services Scotland for facilitating access and analysis of the Scottish cohort. The authors thank the National Cancer Registry Ireland and the Irish Health Services Executive Primary Care Reimbursements Services for providing access to the data upon which this study was based.
Funding Information:
The work on the English dataset was supported by a project funding grant from Cancer Research-UK (C19630/A13265). The work on the UK datasets was supported by a United Kingdom National Institute for Health Research Career Development Fellowship to CRC funded by the Health and Social Care Research and Development Division (Public Health Agency, Northern Ireland). The work on the Ireland dataset was supported by a grant from the Health Research Board in Ireland to CB (HRA_HSR/2012/30).
Publisher Copyright:
© 2016 The Author(s).
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Background: Preclinical studies have demonstrated that propranolol inhibits several pathways involved in breast cancer progression and metastasis. We investigated whether breast cancer patients who used propranolol, or other non-selective beta-blockers, had reduced breast cancer-specific or all-cause mortality in eight European cohorts. Methods: Incident breast cancer patients were identified from eight cancer registries and compiled through the European Cancer Pharmacoepidemiology Network. Propranolol and non-selective beta-blocker use was ascertained for each patient. Breast cancer-specific and all-cause mortality were available for five and eight cohorts, respectively. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) for cancer-specific and all-cause mortality by propranolol and non-selective beta-blocker use. HRs were pooled across cohorts using meta-analysis techniques. Dose-response analyses by number of prescriptions were also performed. Analyses were repeated investigating propranolol use before cancer diagnosis. Results: The combined study population included 55,252 and 133,251 breast cancer patients in the analysis of breast cancer-specific and all-cause mortality respectively. Overall, there was no association between propranolol use after diagnosis of breast cancer and breast cancer-specific or all-cause mortality (fully adjusted HR = 0.94, 95% CI, 0.77, 1.16 and HR = 1.09, 95% CI, 0.93, 1.28, respectively). There was little evidence of a dose-response relationship. There was also no association between propranolol use before breast cancer diagnosis and breast cancer-specific or all-cause mortality (fully adjusted HR = 1.03, 95% CI, 0.86, 1.22 and HR = 1.02, 95% CI, 0.94, 1.10, respectively). Similar null associations were observed for non-selective beta-blockers. Conclusions: In this large pooled analysis of breast cancer patients, use of propranolol or non-selective beta-blockers was not associated with improved survival.
AB - Background: Preclinical studies have demonstrated that propranolol inhibits several pathways involved in breast cancer progression and metastasis. We investigated whether breast cancer patients who used propranolol, or other non-selective beta-blockers, had reduced breast cancer-specific or all-cause mortality in eight European cohorts. Methods: Incident breast cancer patients were identified from eight cancer registries and compiled through the European Cancer Pharmacoepidemiology Network. Propranolol and non-selective beta-blocker use was ascertained for each patient. Breast cancer-specific and all-cause mortality were available for five and eight cohorts, respectively. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) for cancer-specific and all-cause mortality by propranolol and non-selective beta-blocker use. HRs were pooled across cohorts using meta-analysis techniques. Dose-response analyses by number of prescriptions were also performed. Analyses were repeated investigating propranolol use before cancer diagnosis. Results: The combined study population included 55,252 and 133,251 breast cancer patients in the analysis of breast cancer-specific and all-cause mortality respectively. Overall, there was no association between propranolol use after diagnosis of breast cancer and breast cancer-specific or all-cause mortality (fully adjusted HR = 0.94, 95% CI, 0.77, 1.16 and HR = 1.09, 95% CI, 0.93, 1.28, respectively). There was little evidence of a dose-response relationship. There was also no association between propranolol use before breast cancer diagnosis and breast cancer-specific or all-cause mortality (fully adjusted HR = 1.03, 95% CI, 0.86, 1.22 and HR = 1.02, 95% CI, 0.94, 1.10, respectively). Similar null associations were observed for non-selective beta-blockers. Conclusions: In this large pooled analysis of breast cancer patients, use of propranolol or non-selective beta-blockers was not associated with improved survival.
KW - Beta-blocker
KW - Breast cancer
KW - Cohort
KW - Mortality
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U2 - 10.1186/s13058-016-0782-5
DO - 10.1186/s13058-016-0782-5
M3 - Article
C2 - 27906047
AN - SCOPUS:84999752067
VL - 18
JO - Breast Cancer Research
JF - Breast Cancer Research
SN - 1465-5411
IS - 1
M1 - 119
ER -