Statin use and patterns of breast cancer recurrence in the Malmö Diet and Cancer Study

Abstract

Background: Accumulating evidence suggests that statins have a beneficial effect on breast cancer prognosis. Previous studies have reported a positive association between statin use and breast cancer survival; however, the relationship between statin use and patterns of breast cancer recurrence remains unclear.Patients and methods: We identified all Malm€ o Diet and Cancer Study (MDCS) participants diagnosed with incident invasive breast cancer between 2005 and 2014. The follow-up period began at breast cancer diagnosis and continued until the first invasive breast cancer recurrence event, death, emigration or the end of the follow-up (June 8, 2020). We estimated incidence rates (IRs) of recurrence and fit Cox regression models to compute crude and adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) for disease recurrence to compare post-diagnosis statin users with non-users.Results: The final study cohort consisted of 360 eligible patients with a median follow-up of 8.6 years. Overall, there were 71 recurrences in 2932 total person-years. According to statin use, there were 14 recurrences in 595 person-years among statin users, and 57 recurrences in 2337 person-years in nonusers. Statin use was associated with a reduced risk of breast cancer recurrence (HR adj ¼ 0.88 [95% CI: 0.82e0.96]). Regarding the pattern of recurrence, statin use was associated with a reduced risk of distant recurrence (HR adj ¼ 0.86 [95% CI: 0.80e0.94]) but not loco-regional recurrence (HR adj ¼ 0.97 [95% CI: 0.87e1.08]). Conclusion: In the MDCS, statin use was associated with a reduced risk of distant breast cancer recurrence, whereas no association between statin use and loco-regional breast cancer recurrence was found. This site-based difference in disease recurrence may be explained by statin's inhibition of epithelialmesenchymal transition.

Incidence and Risk Factors for Venous Thromboembolism in Female Patients Undergoing Breast Surgery

“…The knowledge about the risk factors of VTE could be helpful as a piece of prognostic information, but also to eventually target preventive treatment for VTE, since the co-existence of invasive breast cancer and VTE has a significant impact on survival. In particular, new evidence suggests, in humans, a beneficial effect of statins in reducing the risk of breast cancer distant metastasis and in reducing the risk of VTE recurrence [ 61 , 62 , 63 ].…”

Interplay between Caveolin-1 and body and tumor size affects clinical outcomes in breast cancer

“…Interestingly, in vitro and in vivo studies have shown that statins inhibit and lower CAV1 levels, hindering its oncogenic role [ 39 , 40 ]. A recent study reported post-diagnostic statin use to protect against distant but not locoregional recurrences [41] , but CAV1’s role in this setting is unknown.…”

Commentary: Involvement of LDL and ox-LDL in Cancer Development and Its Therapeutical Potential

“…A possibility is that cholesterol-lowering may protect against metastases. In the CARE trial ( 7 ), significantly more women in the treatment group suffered from breast cancer, but in a recent study, 360 women with breast cancer were followed for 23 years ( 21 ). After exclusion of those with prediagnostic statin use and those with breast cancer in situ, those who had been prescribed statin treatment during the observation period suffered less often from breast cancer recurrence and lived longer than the untreated.…”