# Impact of Hypertension on Cancer Stage at Diagnosis Among French Women: The E3N Prospective Cohort

## TL;DR

This study found that hypertension in French women is linked to cancer stage at diagnosis, with treatment and screening habits influencing the outcomes.

## Contribution

The study reveals how hypertension treatment and screening frequency affect cancer metastasis at diagnosis in a large cohort.

## Key findings

- Untreated hypertension increased metastatic cancer risk in regularly screened women.
- Treated hypertension was linked to higher odds of metastatic thyroid cancer but lower odds for lung cancer.
- Time from hypertension onset showed a nonlinear inverse association with metastatic lung cancer.

## Abstract

Hypertension may delay the detection of metastatic cancers. We investigated the association between incident hypertension and the risk of metastatic onset among female cancer patients. We studied notably the role of anti‐hypertensive treatment and the time between hypertension onset and cancer diagnosis in this association.

E3N is a French prospective population‐based cohort that recruited 98,995 women in 1990. A total of 7844 incident invasive cancers were examined. We used multivariate logistic regression models to calculate odds ratios (OR) and their 95% confidence intervals (CI). We also used restricted cubic splines to evaluate the nonlinear dose–response associations between hypertension duration and the risk of metastatic onset (vs. localised stage).

A total of 1994 cases (25%) of incident hypertension occurred before cancer diagnosis. Compared to non‐hypertensive patients, those with untreated hypertension presented more frequently with metastatic cancer among patients who regularly underwent cancer screening (OR = 1.69, 95% CI = 1.11–2.58). This association was inverse among those who did not screen regularly (OR = 0.53, 95 CI = 0.29‐0.98). Treated hypertensive patients had significantly greater odds of metastatic presentation for thyroid (OR = 2.45, 95% CI = 1.01–5.91) and lower odds for lung (OR = 0.17, 95% CI = 0.06–0.52) cancer. A significant inverse U‐shaped association with time from hypertension onset (p = 0.01) was observed.

In this study, hypertension was associated with metastatic cancer presentation, but cancer screening determined the direction of the association. Time from hypertension onset was inversely associated with metastatic lung cancer, with a significant nonlinear dose–response relationship. Our findings call for further research in this area to investigate the underlying mechanisms.

clinicaltrials.gov identifier: NCT03285230

Time from hypertension onset and anti‐hypertensive drugs were important determinants in the cancer stage at diagnosis in the French E3N cohort. Treated hypertension increased the odds of metastatic thyroid cancer diagnosis, whereas it lowered those odds for lung cancer. We showed that time from hypertension onset had a significant nonlinear dose–response relationship for metastatic lung cancer at diagnosis.