Beta Blockers and Breast Cancer Mortality

joetmn

https://medicine.tcd.ie/bulletin/april-2012/21632503.pdf

...

There were four (8.9%) breast cancer–specific deaths among
propranolol users for an incidence rate of 26.5 per 1,000 woman years
and 20 (22.2%) deaths among nonusers matched by age, tumor grade,
tumor stage, and comorbidity for an incidence rate of 67.9 per 1,000
woman years (Table 4).

The median follow-up was 3.5 years for
propranolol users and 3.6 years for matched nonusers. The median
duration of propranolol exposure post breast cancer diagnosis was
1.92 years. The median daily dose of propranolol during this time was
60 mg.

At 5 years post breast cancer diagnosis, the risk of breast
cancer–specific mortality was 81% lower for propranolol users
than for nonusers (Fig 2A; Table 4; HR, 0.19; 95% CI, 0.06 to 0.60).
Rates of non–breast cancer–specific mortality were similar between
propranolol users and nonusers. There was no difference in
the cumulative probability of breast cancer–specific mortality between
atenolol users and matched nonusers, 26.8% v 26.0% (Fig
2B; Table 4; HR, 1.08; 95% CI, 0.84 to 1.40). These analyses were
repeated, excluding patients with stage IV breast tumors.

Propranolol users continued to have a significantly lower risk of breast
cancer–specific mortality, compared with matched nonusers (HR,
0.20; 95% CI, 0.04 to 0.94). There was no difference in breast
cancer–specific mortality between atenolol users and matched
nonusers (HR, 1.16; 95% CI, 0.84 to 1.61).

NattyOnFrostyLake

One of my doctors suggests this drug as part of the breast cancer protocol. I'm glad to see you post about it since it is considered one of more sophisticated approaches. A doctor who suggests it would usually have been around a long time.

Got any more juicy stuff?

Thanks!

placid44

Thanks, Joetmn. I saw this also. I was on atenolol for high blood pressure, so I switched to propranolol in January, while on chemo, and plan to stay on it. It is supposed to be good for triple negatives.



The theory is that it blocks stress hormones. Atenolol only blocks one pathway; propranolol blocks both/two.

leggo

Hmmm, I recently added atenelol to my regimen because of a study my doctor showed me. Reading your post placid, has me questioning the choice of which beta blocker. Could you elaborate on how propanolol blocks both? I googled it but it all that pathway jargon makes little sense to me. If propanolol is better, I really want to ask to switch. Also, does anyone know if one drug is stronger than the other? Reason I ask is when I discussed this with my doctor he said atenolol was the weaker of the beta blockers which would be better for someone who DOES NOT have high blood pressure (which I don't), and that propanolol would bring it down to low. Now I'm questioning if this is true. Any advice/info?

joetmn

NattyGroves,

The attached is the more details paper I have seen so far.  Indeed, the whole machanism is related to stress.

However, I would say that the HR = 0.19 as compared to non user is a quite a good figure.

Gracie,

In fact, the pathway for is different.  Atenelol is a beta 1 blocker and propranolol is a beta 2 blocker.

However, it is unfortunate that propranolol has significant improvement for stage 1 to 3 patients, but not the stage 4 patients.

leggo

Thanks joetmn. I'll have to do a bit more research about the difference in pathways and talk to my doctor some more. My understanding of the whole pathway thing is limited, but I'm hoping someone confirms the assumption I'm under... Atenolol is a-kin to taking a baby aspirin, lowers blood pressure, thins the blood and the like; and that propanolol would be a little dangerous for someone without high blood pressure because it also significantly reduces the heart rate (probably only in high doses).  Can anyone confirm? I suppose my doctor will answer these questions, but it's nice to have confirmation from another source as well.

joetmn

gracie1, propanolol shall take more care for using.  People usually start from small dosage and add up.  And it is danguaous to stop it suddenly...so far as I know.

Jelson

Joetmn - here is a thread about another study comparing woman with breast cancer on beta blockers and ace inhibitors and no bp meds. within the thread is a link to the original study.

http://community.breastcancer.org/forum/67/topic/768988?page=1#post_2399432

I have been taking an ace inhibitor but having been advised by my allergist to get off the ace inhibitor and by both my allergist and primary to avoid the beta blockers - today I start an ARB!!!

the allergist says the beta blockers will reduce my response to rescue drugs such as epinephrine while the ace inhibitor will enhance my reaction to the bee, wasp or vespid sting.

the primary says my heart rate is slow to begin with and the beta blocker (at therapeutic levels) would make me feel lethargic.

IDCERPR

@leggo: were you able to get the answer from your doc?

I am attaching the link of an articlehttp://www.sciencedirect.com/science/article/pii/S1044579X13000850 that outlines about the specific type of beta adrenergic system response according to cancer type ( for the breast: beta 1 and beta 2) .

Propranolol is non selective so it can target both betas vs atenolol is selective for beta 1 only.

How was the outcome ?