Statin Use and Cancer Risk Reduction News

I’m not a statins’ fan, I have a personal negative impression about these drugs, not specially related to anything but their name - “something-statin …” sounds bad (but sounds that it can “stat” certain cancers development). Beside my personal opinion, more and more evidence is available about the “generic” benefit of its use, at least in cancer risk reduction.
Long-term treatment with statins helps reduce cholesterol levels, heart attack and stroke incidence. There is good evidence about these benefits and these drugs are approved for this use (see links below).

The discussion now is about incidental benefits… two recent reports, from BMJ and JCO discusses the unintended effect of statins in England and Wales and the better outcome of men with prostate cancer using this class of drugs at Chicago University.

The facts:

The England and Wales study was a huge cohort study, with 2 million patients included, read it:
“Individual statins were not significantly associated with risk of Parkinson’s disease, rheumatoid arthritis, venous thromboembolism, dementia, osteoporotic fracture, gastric cancer, colon cancer, lung cancer, melanoma, renal cancer, breast cancer, or prostate cancer. Statin use was associated with decreased risks of oesophageal cancer but increased risks of moderate or serious liver dysfunction, acute renal failure, moderate or serious myopathy, and cataract. Adverse effects were similar across statin types for each outcome except liver dysfunction where risks were highest for fluvastatin. A dose-response effect was apparent for acute renal failure and liver dysfunction. All increased risks persisted during treatment and were highest in the first year.”

The study can be considered negative except for the esophageal cancer reduction, with considerable risk of toxic effects (liver, muscles, kidney, eyes). The study has a broad and generic view, and authors consider that future studies with individualized risk analysis are needed.

The University of Chicago Study identified better outcome for patients using statins and treated for prostate cancer. It is a retrospective study with 691 men, 189 used statins and all were treated between 1988 and 2006. Patients under statins stood longer without biochemical recurrence, longer for salvage treatment and longer relapse-free survival. In their analysis, lower levels of cholesterol (mainly LDL) were associated with better outcome from low to high risk patients.

We had preclinical evidence of potential anticancer activity of statins with antiproliferative, proapoptotic, and radiosensitizing properties.
Now we have some reasonable clinical evidence.

So what?

Should I get some statin pills to prevent prostate or esophageal cancer?
Or should I exercise to reduce my LDL level (where probably the benefit stands)?

Keep moving….

Link to evidence of benefit about statins use: http://ht.ly/1R7cM
England and Wales study: http://ht.ly/1R7iT
Chicago Study: http://ht.ly/1R7eS

Fixing Medicare’s Physician Payment System, going to the non-lean solution: cutting wages….

Most of us in Brazil know where this kind of solution is going to end: poorer services, higher costs, neglected quality…. Cut workers income is the best solution to worsen performance… any lean beginner is aware about the impact of cutting costs by cutting wages and personnel, it is formally recommended not to do such things…healthcare reform starts on that.
Back in Brazil quite similar reform took place few decades ago… the impact on healthcare quality is measurable: Brazil doesn’t have 500 (yes, it’s less than five hundred) nationally certified healthcare units/centers (hospitals, labs, clinics, etc.). Brazil has 200 million inhabitants and more than 200,000 healthcare units/centers. Sao Paulo State concentrates 2/3 of these quality certificates, and has more than 50,000 healthcare units/centers. Nobody worried about quality assurance…
Cut costs by cutting service reimbursement are another form of what people now call “brazilification” (I heard it for the first time back in 2000, now it’s getting popular…).
See NEJM publication: http://ht.ly/1IoJa

More on Vitamin D: breast cancer prevention

Recent report published in the American Journal of Clinical Nutrition found that women who take supplemental vitamin D (400IU/day) had reduced risk for breast cancer of more than 20%. No dose-response relationship was observed nor association with daily calcium or other vitamin intake.

Dietary intake of Vitamin D was a confounding factor and possibly biasing the results, but not affecting the risk. The study involved patients from the Ontario Cancer Registry diagnosed and a control group between 2002 and 2003. Authors used epidemiologic questionnaires and analyzed more than 6,000 women.

Once again seems that vitamin D intake is protective… see more at:

article abstract: http://ht.ly/1G49K

The Institute of Medicine (http://www.iom.edu/) will release this month a report about vitamin D adequate daily intake.

The www.veganhealth.com, info about calcium and vitamin D: http://ow.ly/1z4gE.

The University of Michigan, info about calcium and vitamin D: http://ow.ly/1z4hT.

Comments at Medscape: http://ht.ly/1G3P5 (for registered users).

Saving lives with colonoscopy: colorectal cancer mortality drops if you do it at least once in lifetime.

Flexible sigmoidoscopy offered at least once for men and women between 55 and 64 years has significant impact in colon cancer mortality.
Study involving more than 170,000 women and men selected a group invited for screening or control group. Primary outcome was incidence and mortality from colorectal cancer. Based on intention to treat analysis, the colorectal cancer incidence in intervention group reduced 23% and mortality by 31%. Using per-protocol analysis the reduction reached 33% and 43% for incidence and mortality, respectively.
These numbers are impressive and reinforce the role of colonoscopy now clearly associated with colorectal cancer mortality.

So, what to do?

If you are over 55 do it at least once, with long lasting benefits.

See article at The Lancet: http://ht.ly/1E6Fo

Do Breast Cancer Screening Saves Lives?

A recent study published at the British Medical Journal (march 2010) was unable to find any benefit associated with the breast cancer screening program on breast cancer mortality. There was no difference between screened and non screened areas considering breast cancer mortality eluding the idea that mammography for screening has no importance at all…ops!!!

Intriguingly, the study found a mortality decline of 1% per year in the screening areas and 2% decline in non-screening areas for the same 10 year period. For patients too old to be screened there was no difference in breast cancer mortality and for patients too young to benefit from screening (35-55 years old) the mortality declined 5% per year during 1997-2006 in screened and 6% in non-screened areas.

The study included all Danish women recorded in the Cancer Registry from 1971-2006. They used the population of Copenhagen as the screened population (that began in 1991) and all other areas as non-screened areas.

A previous study attributed to screening a reduction in 25% of breast cancer mortality in women living in Copenhagen. As the authors say “there are, however, substantial problems in using observational studies to estimate the effect of screening. For example, a decline in breast cancer mortality following the introduction of screening would not necessarily be caused by screening”. Actually, most benefit associated with recent breast cancer mortality reduction can be attributed to better and more effective treatment.

So what to do?

Well… I would keep the screening … all available data is too biased to be conclusive…

What we really know: Breast cancer mortality decline is clearly associated with our steady effort to diagnose and introduce effective treatment earlier. Today, virtually all women with breast cancer are candidate to adjuvant treatment…

See article: KJ Jørgensen, et al BMJ 2010;340:c1241 http://ht.ly/1DPq1
See different opinion from another study (at msnbc): http://ht.ly/1DPvl

Tamoxifen, raloxifen and breast cancer risk reduction

Presented at the AACR 2010’s Meeting, the NCI sponsored STAR (Study of Tamoxifen and Raloxifen) trial confirms the breast cancer development risk reduction in postmenopausal women considered at a higher risk. 19,000 women participated and tamoxifen and raloxifen reduced de incidence of invasive and noninvasive breast cancer. Raloxifen is safer (less side effects) but less effective than tamoxifen. See JNCI Cancer Bulletin: http://ow.ly/1BvRe

Bisphosphonates use reduces breast cancer risk?

Bisphosphonates use reduces breast cancer risk?

Another study identifies the risk reduction of breast cancer development in women using bisphosphonates for osteoporosis.

Its getting even more frequent the “incidental” finding of cancer risk reduction in studies using non steroid anti-inflammatory agents, bisphosphonates and statins. These findings are relevant clues about the role of inflammation and cancer development. There is a growing evidence that inflammation is pivotal in cancinogenesis… it´s the second post about it this week.

Follow the link from BJC: : http://ow.ly/1A0ed