breast cancer and cholesterol lowering meds

There has been a lot of confusion about the effects of cholesterol lowering medicines (statins) and breast cancer recurrence.  A recent article in the Journal of the National Cancer Institute has brought some clarity (not crystal clear just yet) to the issue.

Statin Prescriptions and Breast Cancer Recurrence Risk

A Danish Nationwide Prospective Cohort Study

Journal of the National Cancer Institute. 2011;103(19):1461-1468.

The confusion has been when the entire class of statins are analyzed for their effect on breast cancer recurrence.  As a group, statins have little if any effect on breast cancer recurrence; however, not all statins are created equal.  Some statins have no effect on breast cancer recurrence - pravastatin (Pravachol) while others clearly decrease the risk of recurrence - simvastatin (Zocor) and some falling in between - atorvastatin (Lipitor).  It turns out that the reason has to do with their chemical nature.  Lipophilic (lipid loving) statins like Zocor have less liver uptake allowing more exposure to peripheral tissues (presumably where they have their breast cancer lowering effect).  Hydrophilic (water loving) statins like Pravachol are taken up more readily in the liver decreasing their effects in pheripheral tissues and hence having no effect on breast cancer recurrence.  So if you have had breast cancer AND need your cholesterol reduced, suggest Zocor (or Lipitor) to your physician - the effects aren't huge but every little bit helps!

Screening Mammography: Is the Sacred Cow headed to Morton's?

In a blog Dr. Presant discusses a new study

Just ordering a mammogram has been simple, instantaneous, and no need for much counseling. And because of its simplicity, this needed only a low level office visit.

But the publication of the results of 10 years follow up in the NCI funded Breast Cancer Surveillance Consortium (BCSC) in Annals of Int Med 2011; 155: 481 by R.A. Hubbard and coauthors teaches us a different process is medically necessary.

In the 169,456 women who had their first mammogram between 1994 and 2006 with annual re-screening mammograms, by 10 years an astounding 61.3% had been returned at least once for a false positive recall exam. Also,  7% (1 woman in 14) had a biopsy recommended and performed which was a false positive.

Since recall exams and biopsies are most stressful for both the patient as well as their spouse, friends or family, more counseling by us when we order a mammogram is necessary. Awareness of the high frequency of false positive recalls and biopsies can reduce stress and apprehension, while still maintaining the currently recommend frequency of screening to detect early stage, more highly curable cancers. When documented in the medical note, such counseling and discussion should result in higher level codes for such visits. 

Without such guidance by us, compliance with annual mammography schedules will reduce and later stage cancers will increasingly be diagnosed. We should implement this discussion with our patients, their families, and in our communities at, for example, tumor board discussions about breast cancer patients.

However I would look at the 'problem' as an opportunity....

We are in an era of targeted therapy - tailoring the treatment to the patient's specific cancer. Shouldn't we be doing targeted screening - performing risk assessment on all patients (Tyrer-Cusick, Gail, BrevaGen (SNP analysis)) and then putting our resources toward the appropriate patient's risk (and away from the lower risk patients)? This would increase true positive biopsies and markedly decrease the denominator (removing the low risk patients) which would increase specificity. We have to let the sacred cow of screening mammography for all women go out to pasture....

Antiperspirant and breast cancer

Emails circulating since 1999 have stated that antiperspirant use is a cause of breast cancer. Urbanlengends.com listes this as unsubstantiated and Snopes.com listed it as 'undetermined'.  One of the main proponents of this 'hypothesis' is Kris McGrath, MD from Northwestern University Medical School.  His article http://www.ncbi.nlm.nih.gov/pubmed/14639125 suggested that early use of antiperspirants and frequent axillary shaving were more common in women diagnosed earlier in life compared to use adn frequency in women diagnosed when they were older.  Circumstantial and circuitous logic that has never been substantiated.  The myth has been rejected by essentially all prominent breast cancer specialists  and organizations including the American Cancer Society which has a nice layman's discussion of the issues http://www.cancer.org/Cancer/CancerCauses/OtherCarcinogens/AtHome/antiperspirants-and-breast-cancer-risk

So don't worry - you can shave your underarms and use antiperspirant without raising your breast cancer risk!!