Dr. Ahmed Spironolactone is frequently used off-label in the treatment of acne, hidradenitis, androgenetic alopecia, and hirsutism. It was initially approved for the management of heart failure, hypertension, and edema.
However, the US Food and Drug Administration has issued a formal warning about the possibility of tumorigenicity for spironolactone.
In women, spironolactone may elevate estrogen and reduce the levels of androgens resulting in normalizing menstrual irregularities and hirsutism.
In men, the association between spironolactone and estrogen-positive breast cancer seems hypothetically stronger than in women. However, few studies that have been conducted have not shown any association between spironolactone and estrogen-positive breast cancer [Ref]
Breast enlargement with spironolactone is common and one should not fear it. However, a discrete lump in the breast or axilla should always be investigated.
So we will discuss the relation of spironolactone usage in breast cancer patients.
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What is spironolactone?
Spironolactone is used to treat some individuals with heart failure, low potassium levels, hyperaldosteronism (in which the body produces too much aldosterone), and edema (fluid retention) brought on by a variety of illnesses, such as liver or kidney disease.
High blood pressure can also be treated with it on its own or in combination with other drugs. The drug spironolactone belongs to a group of drugs known as aldosterone receptor antagonists.
Although it lessens potassium loss from the body, it causes the kidneys to excrete more water and sodium into the urine.
How is Spironolactone Used?
Spironolactone is available as a liquid suspension (Carospir) and tablet for oral consumption. Typically, it is consumed once or twice a day.
Consistently take spironolactone suspension either with or without food. Spironolactone should be taken every day at roughly the same time(s).
Ask your doctor or pharmacist to explain any instructions on your prescription label that you are unsure about following. Spironolactone should be taken as prescribed.
Never take it in larger or fewer amounts or more frequently than directed by your doctor.
Spironolactone and Breast Cancer?
Spironolactone is an anti-androgenic potassium-sparing diuretic. It reduces the blood levels of male hormones or androgens in both men and women.
Because it reduces androgens, in men, it is commonly associated with breast enlargement. In women, this effect is utilized for the treatment of acne, hirsutism, and menstrual irregularities.
Spironolactone use is associated with breast enlargement. There is a hypothetical risk of breast cancer as well.
A study from 2013: Spironolactone, Furosemide, and Breast Cancer!
According to a study, breast, uterine, ovary, and cervix cancer rates were usually elevated by around 10% to 30% in both spironolactone and furosemide users among 2.3 million women (28.5 million person-years).
The incidence of certain cancers increased over the first year after medication exposure, particularly ovarian cancer.
Although they occurred with both spironolactone and furosemide, the incidence increases in the first year of usage were not just for estrogen-sensitive malignancies and were triggered by exposures just before diagnosis.
However, the same study believed that there is no proof that using spironolactone or furosemide increases the chance of developing breast, uterine, ovarian, or cervical cancer. [ref]
On another note, some people may have breast discomfort and gynecomastia from this medication.
A study from 2016: No cancer risk!
This study believed that there was no association found between breast cancer risk and the use of spironolactone after examining women who used it for 4 to 5 years. [ref]
A study from 2020: Spironolactone may be used to treat hair loss in breast cancer survivors!
According to a study from the Department of Dermatology at George Washington University (GW), spironolactone is not linked to a higher risk of female breast cancer recurrence.
The medicine may be appropriate for use in treating breast cancer survivors with female pattern hair loss.
According to this study, which was published in the Journal of the American Academy of Dermatology. [ref]
A study from 2022: No link with breast cancer, Reduced link with prostate cancer!
Spironolactone use was not significantly linked to an increased risk of cancer (such as breast cancer) in a systematic review and meta-analysis.
However, it was linked to a lower risk of prostate cancer. Future research is required, including among varied demographics like younger people and those who have acne or hirsutism. It is because the certainty of the evidence given before was poor. [ref]
Is Spironolactone safe for use in other cancers?
Spironolactone is a well-known potassium-sparing diuretic. It is prescribed to treat ascites in cancer patients, hypertension brought on by an unfavorable reaction to anti-angiogenesis medications, and cerebral edema brought on by brain tumors.
Spironolactone is therefore a medicine that is well tolerated even in cancer patients. According to recent studies, spironolactone suppresses DNA damage repair.
It also functions as a chemosensitizer when combined with DNA-damaging drugs like cisplatin to inhibit cancer growth.
In light of drug repositioning, spironolactone is a solid candidate medicine for the treatment of cancer.
Spironolactone may help anticancer drugs that do not damage DNA become more effective, but this is yet unknown. [ref]
In Conclusion:
Most of the studies suggest that spironolactone is not associated with breast cancer. Spironolactone has even been used to treat hair loss in breast cancer survivors.
There have been case reports of “Spironolactone-Induced Adenocarcinoma of the Breast” in men. However, data is very limited.
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