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Les statines en prévention des cancers
2005 ASCO Annual Meeting - www.asco.org

De plus en plus d'études concordent pour attribuer aux statines un effet préventif contre les cancers. Cancer du poumon, de la prostate, du sein, du pancréas, de l'œsophage ou du côlon, les résultats vont tous dans le même sens, annonçant une réduction du risque cancéreux, dépassant souvent les 50% !

La question qui va falloir maintenat poser et élucider : les statines joueront-elles un rôle important dans la prévention du cancer et pour quelles populations le bénéfice sera-il supérieur aux risques et inconvénient.... et en évaluer le coût financier ou les économies...

CANCER DU SEIN

Une étude à partir de 40.000 femmes montre que le risque de cancer du sein est deux fois moins élevé (51%) chez celles recevant un traitement par statines.

Statins reduce breast cancer risk: a case control study in US female veterans
R. Kochhar, V. Khurana, R. Kochhar, H. Bejjanki, G. Caldito, C. Fort

Background: Statins (HMG CoA reductase inhibitors) are commonly used cholesterol-lowering agents that are noted to suppress tumor growth in several animal models, however clinical data for chemoprotective role of statins in breast cancer is conflicting. While some studies report reduced risk of breast cancer with lipid lowering drugs, others report an increased risk. We investigated the effect of statins on the development of breast cancer in the US female veteran population.
Methods: The VISN 16 database, which contains clinical and demographic information about all veterans (>1.4 million patients) cared for in the South Central VA Health Care Network, was queried from Oct 1998 to June 2004. Retrospective case control design was used. Patients were placed in the statin users group if they were taking statins prior to the diagnosis of breast cancer but the dose, duration and type of statin used was not factored into the analysis. Statistical analysis was performed using SAS software version 9.0 (Chicago, IL). Multiple logistic regression analysis was used with calculation of odds ratios and 95% confidence intervals. The data was adjusted for age, smoking, alcohol use and diabetes.
Results: A total of 40,421 women were studied. The median age was 58 (range 25-92) years. 4771 (11.8%) were on statins. Breast cancer was seen in 556 (1.38%) women. Statin users were less likely to develop breast cancer (Odds ratio 0.49: 95% CI 0.38-0.62, p=<0.0001). The data was controlled for age (OR 1.051, 95% CI 1.045 -1.056, p=<0.0001), smoking (OR 1.82, 95% CI 1.25 -2.65, p=0.002), alcohol use (OR 1.87, 95% CI 1.56 -2.25, p=<0.0001), and diabetes (OR 1.83, 95% CI 1.46 -2.30, p=<0.0001). All these were significant covariates.
Conclusions: Statins are associated with a 51% risk reduction of breast cancer after controlling for age, smoking, alcohol use and diabetes. An internal consistency of the database is reflected by an increased risk associated with documented risk factors.


CANCER DU POUMON

Une de ces études a porté sur une population de 500.000 hommes, dont 34% étaient traités par statines. Les auteurs constatent que les sujets sous statines présentaient une baisse de 48% du risque de cancer du poumon.

Statins reduce the incidence of lung cancer: a study of half a million US veterans
Author(s): V. Khurana, R. Kochhar, H. R. Bejjanki, G. Caldito, C. Fort

Background: Statins (HMG CoA reductase inhibitors) are commonly used cholesterol-lowering agents that are noted to suppress tumor growth in several animal models, however clinical data for a chemoprotective role of statins in lung cancer is lacking. We investigated the effect of statins on the development of lung cancer in the US veteran population.
Methods: The VISN 16 database, which contains clinical and demographic information about all veterans (>1.4 million patients) cared for in the South Central VA Health Care Network, was queried from Oct 1998 to June 2004. Retrospective case control design was used. Patients were included in the statin users group if they were using statins prior to the diagnosis of lung cancer but the dose, duration and type of statin used was not factored into the analysis. Statistical analysis was performed using SAS software version 9.0 (Chicago, IL). Multiple logistic regression analysis was used with calculation of odds ratios and 95% confidence intervals. The data was adjusted for age, gender, smoking and alcohol use.
Results: A total of 484,226 patients were studied. The mean age was 61.2 (SD+/-15.1) years and 91.7% were men, 164,645 (34%) were using statins. Lung cancer (ICD code of 162) was seen in 7280 (1.5%); 1994 (1.2%) statin users and 5286 (1.7%) statin non-users. Statin users were less likely to develop lung cancer (Odds ratio 0.52: 95% CI 0.49-0.55). The data was controlled for age (OR 1.038, 95% CI for OR 1.036-1.039, p=<0.0001), gender (OR 0.42, 95% CI for OR 0.36-0.49, p=<0.0001), smoking (OR 1.80, 95% CI for OR 1.66-1.95, p=<0.0001), and alcohol use (OR 1.13, 95% CI for OR 1.08-1.19, p=<0.001). All these were highly significant covariates.
Conclusions: Statins are associated with a 48% risk reduction of lung cancer after controlling for age, gender, smoking and alcohol use. An internal consistency of the database is reflected by an increased risk associated with documented risk factors. Our data should be evaluated with caution, given the limitations of the population, the database and the fact that this is a case control study. Some factors known to increase the risk of lung cancer like asbestos exposure were not incorporated into the study. Associated Presentation(s):


CANCER DE LA PROSTATE

En examinant une cohorte de 450.000 hommes, un autre essai conclut à une baisse de 54% du risque de cancer de la prostate sous statine. Ici, les auteurs ont noté un effet bénéfique croissant avec la durée du traitement. Ainsi, un traitement de un à deux ans a été associé à une baisse du risque de 27%, deux à trois ans de traitement à une baisse de 58%, tandis que trois à quatre ans de prescription baisse le risque de 70%. Et enfin, si le traitement a été suivi durant plus de quatre ans, la baisse enregistrée atteint 89% !!!

STATINS AND PROSTATE CANCER RISK: A LARGE CASE CONTROL STUDY IN VETERANS.
Author(s): R. Singal, V. Khurana, G. Caldito, C. Fort

Abstract: Background: Hydroxymethylglutaryl-CoA reductase inhibitors (statins)are commonly used to control high cholesterol. These agents that have been shown to induce apoptosis and inhibiting tumour growth and metastasis in human cancer cell lines and animal tumour models. We studied the association of prostate cancer and statins in veterans.
Methods: VISN 16 data warehouse, which contains clinical and demographic information about all veterans (>1.4 million patients) cared for at the 10 VA Medical Centers in 4 states comprising the South Central VA health Care Network in the mid-south region of the US, was queried from Oct 1998 to June 2004. Retrospective case control design was used. The primary variable of interest was prostate cancer (ICD-9 code 185) and the use of statins prior to the diagnosis of prostate cancer. Multivariate logistic regression analysis was done to adjust for covariates including age, body mass index, smoking, diabetes, and race. Statistical analysis was performed using SAS software version 9.0 (Chicago, IL).
Results: A total of 443,805 patients were evaluated and of these, 159,874 were on statins. A total of 26,139 were diagnosed with prostate cancer. Statin use was associated with a significant protective effect for prostate cancer (Odds ratio 0.46, 95% CI 0.45 to 0.48). The risk factors associated with an increased risk of prostate cancer included age (OR 1.082, 95% CI 1.081 to 1.084), body mass index (OR 1.015, 95% CI 1.012 to 1.018), smoking (OR 1.13, 95% CI 1.07 to 1.120), diabetes (OR 1.09, 95% CI 1.06 to 1.13), and race - blacks vs whites (OR 1.57, 95% CI 1.50 to 1.63).
Conclusions: Statins are protective against the development of prostate cancer after controlling for age, body mass index, smoking, diabetes, and race. An internal consistency of the database is reflected by an increased risk associated with other documented risk facors such as age, race etc. Our data should be evaluated with caution, given the limitations of the population, the database, and this being a case control study. Dose, duration, and particular statin used were not factored into the analysis. If these results are confirmed in a large prospective study they may provide necessary evidence to consider the use of statin drugs in prostate cancer prevention. Associated Presentation(s):


CANCER DU PANCREAS - CANCER DE L'OESPOPHAGE

Le même type d'étude montre que la prise de statines réduit de 59% le risque de cancer du pancréas et de 56% celui de cancer oesophagien.

VOIR EGALEMENT
  • Les statines [Lire]
  • Prévention du cancer colorectal par les statines [Lire]
  • Sclérose en plaques (SEP) et statines [Lire]

    Mais aussi
  • Statines : encore beaucoup d'inconnues (2002) [Lire]
CONCLUSION....

Avec 5 millions de Français déjà traités par les statines, elles représentent la première classe thérapeutique remboursée par l'Assurance maladie.
Si ces données se confirment, les statines pourraient entrer dans une nouvelle aire thérapeutique. Et si les patients déjà sous traitement anti-cholestérol seront les premiers à bénéficier de cet effet anti-cancer des statines, on peut imaginer, dans un avenir assez proche, traiter nombre de personnes avec ces molécules sous le simple prétexte de la prévention contre les cancers.
"Les statines ne sont pas sans risque et pour Ie Dr Khurana qui a participé à cette recherchel il est trop tôt pour prescrire les statines strictement pour réduire les risques de cancer

NB

la Simvastatine (Lodalès ®, Zocor ® ) vient tomber dans le domaine public.
The American Society of Clinical Oncology (ASCO) is the world’s leading professional organization representing physicians of all oncology subspecialties who care for people with cancer. ASCO’s more than 20,000 members from the United States and abroad set the standard for patient care worldwide and lead the fight for more effective cancer treatments, increased funding for clinical and translational research, and, ultimately, cures for the many different types of cancer that strike an estimated 10 million people worldwide each year.
ASCO publishes the Journal of Clinical Oncology (JCO), the preeminent, peer-reviewed, medical journal on clinical cancer research, and produces People Living With Cancer (www.PLWC.org), an award-winning website providing oncologist-vetted cancer information to help patients and families make informed health-care decisions.
www.asco.org
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