|Field Of Vision|
Published online May 10, 2013. doi: 10.5306/wjco.v4.i2.43
Revised: March 28, 2013
Accepted: April 28, 2013
Published online: May 10, 2013
In addition to cholesterol reduction, statins, currently the most commonly prescribed drug in the world, have been shown to have anti-neoplastic and immunomodulatory effects. Several observational studies and meta-analyses have shown reduction in risk of multiple cancers. More recently there has been an increasing interest in the potential role of statins as adjuvant therapy after cancer diagnosis and in modifying cancer mortality. Although post-hoc analyses of randomized controlled trials of statins for cardiovascular outcomes have not shown reduction in the risk of cancer mortality with statin use, these studies lack sufficient power to detect a significant difference in cancer outcomes. Recently, in a Danish nationwide population-based cohort study, Nielsen et al showed a 15% reduction in all-cause and cancer-specific mortality in statin users as compared to non-users. Improved survival with statin exposure was seen in 13/27 cancer subtypes, including the 4 most common cancers - lung, prostate, colorectal and breast. In this commentary, we examine this important study, review its implications and limitations, and briefly discuss impact of other drugs like metformin and aspirin that also exhibit anti-neoplastic effects.
Core tip: With increasing economic burden of cancer care, cost-effective, preventive strategies are in focus. Commonly used drugs like statins, metformin and aspirin have been shown to have anti-neoplastic effects and are attractive candidates for cancer chemoprevention and reducing cancer-related mortality. Recently, in a Danish nationwide population-based cohort study, statin users had 15% reduction in all-cause and cancer-specific mortality as compared to non-users. These results are encouraging and show that statin use may be associated with reduced cancer mortality across different subgroups and cancer sites. However, several confounding variables remain, which merit further evaluation before this can change clinical practice.