QDoes spironolactone use increase the risk of female breast cancer recurrence?

Medically reviewed on 12.1.2022 by James Q. Del Rosso, DO

Not so according to this study by Dr. Wei published in the Journal of the American Academy of Dermatology in 2020.

Although spironolactone had previously not been shown to increase the risk of primary breast cancer development, despite its anti-androgenic and pro-estrogenic effects, historically little was known about its role in disease recurrence.

But when researchers did a retrospective analysis on patients with a history of breast cancer and compared those among this group who were prescribed spironolactone and those who were not, adjusted Cox regression analysis showed no association between spironolactone and increased breast cancer recurrence.

Spironolactone was originally developed as a diuretic used to treat high blood pressure and edema, and later gained popularity in dermatology for its off-label use treating female adult acne and in women struggling with androgenic alopecia, hidradenitis suppurativa, and hirsutism. The usual dosage for these conditions runs between 25mg to 200mg a day.

Side effects can include lightheadedness, breast tenderness, irregular menses and having to urinate frequently. In dermatology, we avoid using spironolactone in men because of the risk of gynecomastia as well as its potential to cause erectile dysfunction and loss of libido. Women should avoid pregnancy while taking spironolactone because of the potential risk of feminization of a male fetus.

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References:

1. Chapman Wei et al. Spironolactone Use Does Not Increase the Risk of Female Breast Cancer Recurrence: A retrospective analysis. J Am Acad Dermatol. 2020 Oct.; 73(5):490-496. doi:10.1001/jamapsychiatry.2016.0060