title: Propranolol and survival from breast cancer: a pooled analysis of European breast cancer cohorts.
abstract: Preclinical studies have demonstrated that propranolol inhibits several pathways involved in breast cancer progression and metastasis. We investigated whether breast cancer patients who used propranolol, or other non-selective beta-blockers, had reduced breast cancer-specific or all-cause mortality in eight European cohorts.
  
  
  
  Incident breast cancer patients were identified from eight cancer registries and compiled through the European Cancer Pharmacoepidemiology Network. Propranolol and non-selective beta-blocker use was ascertained for each patient. Breast cancer-specific and all-cause mortality were available for five and eight cohorts, respectively. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) for cancer-specific and all-cause mortality by propranolol and non-selective beta-blocker use. HRs were pooled across cohorts using meta-analysis techniques. Dose-response analyses by number of prescriptions were also performed. Analyses were repeated investigating propranolol use before cancer diagnosis.
  
  
  
  The combined study population included 55,252 and 133,251 breast cancer patients in the analysis of breast cancer-specific and all-cause mortality respectively. Overall, there was no association between propranolol use after diagnosis of breast cancer and breast cancer-specific or all-cause mortality (fully adjusted HR = 0.94, 95% CI, 0.77, 1.16 and HR = 1.09, 95% CI, 0.93, 1.28, respectively). There was little evidence of a dose-response relationship. There was also no association between propranolol use before breast cancer diagnosis and breast cancer-specific or all-cause mortality (fully adjusted HR = 1.03, 95% CI, 0.86, 1.22 and HR = 1.02, 95% CI, 0.94, 1.10, respectively). Similar null associations were observed for non-selective beta-blockers.
  
  
  
  In this large pooled analysis of breast cancer patients, use of propranolol or non-selective beta-blockers was not associated with improved survival.
authors.affiliation: Institute of Clinical Sciences Block B, Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, BT12 6BA, UK. c.cardwell@qub.ac.uk.
authors.forename: Chris R
authors.initials: CR
authors.lastname: Cardwell
authors.affiliation: Department of Public Health, University of South Denmark, Odense, Denmark.
authors.forename: Anton
authors.initials: A
authors.lastname: Pottegård
authors.affiliation: Research Department, Belgian Cancer Registry, Brussels, Belgium.
authors.forename: Evelien
authors.initials: E
authors.lastname: Vaes
authors.affiliation: Division of Cancer Studies, Cancer Epidemiology Unit, King's College London, London, UK.|Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Garmo
authors.affiliation: Institute of Clinical Sciences Block B, Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
authors.forename: Liam J
authors.initials: LJ
authors.lastname: Murray
authors.affiliation: National Cancer Registry Ireland, Cork, Ireland.
authors.forename: Chris
authors.initials: C
authors.lastname: Brown
authors.affiliation: Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
authors.forename: Pauline A J
authors.initials: PA
authors.lastname: Vissers
authors.affiliation: Institute of Clinical Sciences Block B, Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: O'Rorke
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health and School of Medicine, Baltimore, USA.
authors.forename: Kala
authors.initials: K
authors.lastname: Visvanathan
authors.affiliation: Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Cronin-Fenton
authors.affiliation: Research Department, Belgian Cancer Registry, Brussels, Belgium.
authors.forename: Harlinde
authors.initials: H
authors.lastname: De Schutter
authors.affiliation: Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Lambe
authors.affiliation: Department of Cellular Pathology, Queens Medical Centre, NUH, Nottingham, UK.
authors.forename: Des G
authors.initials: DG
authors.lastname: Powe
authors.affiliation: PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.
authors.forename: Myrthe P P
authors.initials: MP
authors.lastname: van Herk-Sukel
authors.affiliation: Institute of Clinical Sciences Block B, Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, BT12 6BA, UK.|Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Gavin
authors.affiliation: Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Friis
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
authors.affiliation: Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D005060:Europe; D005260:Female; D006801:Humans; D016016:Proportional Hazards Models; D011433:Propranolol / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D020533:Angiogenesis Inhibitors; D011433:Propranolol
keywords: Beta-blocker; Breast cancer; Cohort; Mortality