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Meta-Analysis
. 2022 Oct;127(6):1086-1096.
doi: 10.1038/s41416-022-01891-7. Epub 2022 Jun 20.

β-blockers and breast cancer survival by molecular subtypes: a population-based cohort study and meta-analysis

L Lukas Løfling  1 , Nathalie C Støer  1   2 , Erica K Sloan  3 , Aeson Chang  3 , Sara Gandini  4 , Giske Ursin  5   6   7 , Edoardo Botteri  8   9
Affiliations
Meta-Analysis

β-blockers and breast cancer survival by molecular subtypes: a population-based cohort study and meta-analysis

L Lukas Løfling et al. Br J Cancer. 2022 Oct.

Abstract

Background: The association between use of β-blockers and breast cancer (BC) prognosis has been investigated in several observational studies, with conflicting results. We performed a nationwide cohort study and a meta-analysis to investigate the association, and assess if it varied between molecular subtypes of BC.

Methods: We identified women aged ≥50 years with BC diagnosed between 2004 and 2018 in Norway. We used Cox regression models to estimate the association between β-blocker use at diagnosis and BC-specific survival, overall and by molecular subtype. We performed a meta-analysis of observational studies that reported molecular subtype-specific estimates of this association.

Results: We included 30,060 women, of which 4461 (15%) used β-blockers. After a median follow-up of 5.1 years, 2826 (9%) died of BC. Overall, β-blocker use was not associated with BC-specific survival (hazard ratio [HR] = 1.07; 95% confidence interval [CI]: 0.97-1.19). We found an association only in triple-negative BC (TNBC) patients (HR = 0.66; 95% CI: 0.47-0.91). This was confirmed in the meta-analysis: β-blocker use was associated with progression/recurrence-free (HR = 0.58; 95% CI: 0.38-0.89) and BC-specific survival (HR = 0.74; 95% CI: 0.55-1.00) in TNBC patients only.

Conclusion: In our cohort of BC patients and in the meta-analysis, β-blocker use was associated with prolonged BC-specific survival only in TNBC patients.

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Conflict of interest statement

ES is a scientific advisory board member for Cygnal Therapeutics. The other authors have no competing interests.

Figures

Fig. 1
Fig. 1. Hazard ratios (HR) and 95% confidence intervals (CI) for the association between use of β-blockers (filled prescription within 3 months before the diagnosis) and breast cancer-specific survival, overall and stratified by molecular subtype, receptor status, Ki-67, from 2004 to 2018 in Norway.
Comparison group is all non-users of β-blockers. CI confidence interval, BB β-blocker, ER oestrogen receptor, PR progesterone receptor, HER2 human epidermal growth factor receptor 2.
Fig. 2
Fig. 2. Hazard ratios (HR) and 95% confidence intervals (CI) for the association between use of β-blockers (filled prescription within 3 months before the diagnosis) and breast cancer-specific survival, stratified by stage and molecular subtype further stratified by stage, from 2004 to 2018 in Norway.
Comparison group is all non-users of β-blockers. CI confidence interval, BB β-blocker, HER2 human epidermal growth factor receptor 2.
Fig. 3
Fig. 3. Forest plot of estimates for the association between use of β-blockers and progression-free or recurrence-free survival, stratified by molecular subtype.
Comparison group is users of other antihypertensive medications in the study by Lorona et al. [19] and all non-users of β-blockers in the other studies. HR hazard ratio, CI confidence interval, ER oestrogen receptor, PR progesterone receptor, HER2 human epidermal growth factor receptor 2, RE random effect, TNBC triple-negative breast cancer.
Fig. 4
Fig. 4. Forest plot of estimates for the association between use of β-blockers breast cancer-specific survival, stratified by molecular subtype.
Comparison group is users of other antihypertensive medications in the study by Lorona et al. [19] and in our original cohort study, and all non-users of β-blockers in the other studies. HR hazard ratio, CI confidence interval, ER oestrogen receptor, PR progesterone receptor, HER2 human epidermal growth factor receptor 2, RE random effect, TNBC triple-negative breast cancer.
See this image and copyright information in PMC

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