Spironolactone use does not increase the risk of female breast cancer recurrence: A retrospective analysis

J Am Acad Dermatol. 2020 Oct;83(4):1021-1027. doi: 10.1016/j.jaad.2020.05.081. Epub 2020 May 21.


Background: Spironolactone is used off-label for androgenic alopecia because of its ability to arrest hair loss progression and long-term safety profile. However, little is known about the safety of spironolactone in breast cancer (BC) survivors. Because spironolactone has estrogenic effects, there is a theoretical risk for BC recurrence. Given that spironolactone is an important tool in the treatment of alopecia, we investigated whether spironolactone increased risk for BC recurrence.

Objective: To determine whether spironolactone is associated with increased BC recurrence.

Methods: A retrospective analysis was conducted using the Humana Insurance database. Patients with a history of BC were identified using International Classification of Diseases codes, stratified by spironolactone prescription, and also matched 1:1 using propensity score analysis. Patient characteristics and cancer recurrence rates between both cohorts were compared and analyzed.

Results: BC recurrence developed in 123 patients (16.5%) who were prescribed spironolactone compared with 3649 patients (12.8%) who developed BC recurrence without spironolactone prescribed (P = .004). After propensity matching, adjusted Cox regression analysis showed no association between spironolactone and increased BC recurrence (adjusted hazard ratio, 0.966; 95% confidence interval, 0.807-1.156; P = .953).

Limitations: Retrospective study.

Conclusion: Spironolactone was not independently associated with increased BC recurrence and may be considered for the treatment of alopecia in BC survivors.

Keywords: androgenic alopecia; breast cancer recurrence; female patterned hair loss; spironolactone.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alopecia / drug therapy
  • Breast Neoplasms / epidemiology*
  • Breast Neoplasms / pathology
  • Databases, Factual
  • Female
  • Humans
  • Middle Aged
  • Mineralocorticoid Receptor Antagonists / therapeutic use*
  • Neoplasm Recurrence, Local / epidemiology*
  • Off-Label Use / statistics & numerical data*
  • Propensity Score
  • Proportional Hazards Models
  • Risk Factors
  • Spironolactone / therapeutic use*
  • United States / epidemiology
  • Young Adult


  • Mineralocorticoid Receptor Antagonists
  • Spironolactone