Ovarian cancer: Possible advantage of high blood pressure

Women with a specific type of ovarian cancer seemed to benefit from having a hypertension diagnosis, according to research by epidemiologists at Roswell Park Cancer Institute, published in Cancer Causes & Control.

The research provides evidence that hypertension and diabetes and the use of medications to treat these common conditions may influence the survival of ovarian cancer patients - sometimes in a detrimental way, but in the case of hypertension medications, perhaps as a benefit.

Moysich (right) and Minlikeeva

Using pooled data from 15 studies that were part of the Ovarian Cancer Association Consortium, an international team of collaborators led by Kirsten Moysich, PhD, MS, and Albina Minlikeeva, PhD, MPH, examined the associations between survival among patients diagnosed with invasive epithelial ovarian cancer and those patients’ history of hypertension, heart disease, diabetes, and medications taken for those conditions.

“We found that history of diabetes was associated with increased mortality. Surprisingly, among patients diagnosed with endometrioid ovarian cancer, history of hypertension was inversely associated with risk of progression,” says Moysich, Distinguished Professor of Oncology in the departments of Cancer Prevention and Control and Immunology at the Buffalo, N.Y., cancer center. “We also found that use of certain medications such as oral anti-diabetic medications and insulin was associated with increased risk of dying, and use of diuretics with better survival.”

Researchers found that while a history of diabetes was associated with a 112% higher risk of mortality across more than 7,600 cases, no significant mortality associations were observed for hypertension or heart disease. In fact, the authors report, among women with endometrioid ovarian cancer, a subtype of epithelial ovarian cancer typically associated with better outcomes, hypertension - a condition that applied to nearly 26% of women in the pooled analysis - was associated with 46% lower risk of ovarian cancer progression.

“This is a coincidental and unintended consequence of hypertension and its treatment, but it’s a silver lining to a serious but largely manageable medical condition that has reached epidemic prevalence in the U.S. and many other countries worldwide,” says Moysich.

This study is the first to highlight the role of comorbidities in relation to ovarian cancer survival by histological subtype, and confirmed previous findings linking a history of diabetes to increased risk of death among ovarian cancer patients. It’s possible that commonly prescribed antihypertensive medications, including beta blockers, may influence the growth of ovarian tumors. But the team also documented a higher overall risk of death for patients who had ever taken beta blockers, and notes that further study is needed to better understand these processes and interactions.

“Our results suggest that it is important to investigate factors that explain the difference in cancer outcomes among women with different types of ovarian cancer. Most studies only consider clinical characteristics at diagnosis, such as stage and histology in relation to ovarian cancer prognosis,” says Minlikeeva, a postdoctoral research affiliate with Roswell Park’s Department of Cancer Prevention and Control. “Our findings emphasize the importance of understanding the full clinical profile for women with ovarian cancer in order to predict ovarian cancer outcomes.”

Approximately 22,300 new cases of ovarian cancer are diagnosed each year in the U.S., with an estimated 14,200 women dying from the disease each year. Endometrioid carcinoma accounts for about 20% of all epithelial ovarian cancers.

“The results of our study draw our attention to the necessity of further research investigating the role of antihypertensive medications in relation to prognosis of ovarian cancer patients. Both preclinical and epidemiologic studies may clarify mechanisms for these observations and provide insight regarding treatment,” says Minlikeeva. “Our results also suggest that integration of the full clinical profile for ovarian cancer patients may be essential in understanding the factors related to their overall morbidity and mortality.”