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 Table of Contents  
LETTER TO EDITOR
Year : 2015  |  Volume : 7  |  Issue : 12  |  Page : 577-579

Endometrial cancer and the role of statins


1 Dow University of Health Sciences, Karachi, Pakistan
2 Aga Khan University Hospital, Karachi, Pakistan
3 Ziauddin Medical University, Karachi, Pakistan

Date of Web Publication30-Dec-2015

Correspondence Address:
Ammar Humayun
Dow University of Health Sciences, Karachi
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1947-2714.172855

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How to cite this article:
Humayun A, Khan MS, Haider SA, Arshad MH, Golani E. Endometrial cancer and the role of statins . North Am J Med Sci 2015;7:577-9

How to cite this URL:
Humayun A, Khan MS, Haider SA, Arshad MH, Golani E. Endometrial cancer and the role of statins . North Am J Med Sci [serial online] 2015 [cited 2019 Oct 21];7:577-9. Available from: http://www.najms.org/text.asp?2015/7/12/577/172855

Dear Editor,

According to the new guidelines published by the American College of Cardiology, it is predicted by experts that statins will become one of the most commonly prescribed drugs in the age group of 40-75 years. [1] Statins have been clearly shown to improve morbidity and mortality in patients with cardiovascular diseases. Recently, the beneficial effect of statins on the prognosis and risk of various cancers including gynecological malignancies has also been highlighted in multiple studies.

Endometrial cancer, the most common cancer of the female genital tract, has already caused more than 10,000 mortalities in the United States alone in the year 2015. [2] With advanced-stage endometrial cancer presenting with an extremely poor outcome, it is important that factors that can help to decrease the risk of endometrial cancer should be thoroughly investigated. The role of statins in this regard has been highly debatable in the recent past. In an attempt to collect updated evidence, we conducted an extensive literature search utilizing Medline (PubMed and OvidSP) and Cochrane Library to identify all possible studies that have investigated the impact of statins on the risk and prognosis of endometrial cancer.

Thirteen relevant citations were found [3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] and are shown in [Table 1] and [Table 2]. Three studies [5],[6],[7] showed that statins significantly reduce the risk of developing endometrial cancer while seven studies [8],[9],[10],[11],[12],[13],[14] reported no such relationship. The three studies that documented favorable impact of statins on endometrial cancers were all limited by lack of randomization, single center locations, relatively small sample sizes, and confounders as patients had multiple comorbidities. Only three studies [3],[4],[12] were found that investigated the effect of statins on endometrial cancer survival, which are shown in [Table 2]. Nevadunsky et al.[3] reported that statins significantly (HR = 0.63) prolong survival in patients with endometrial cancer while the other two studies [4],[12] concluded that statins have no significant effect on mortality. These studies have not mentioned if they have looked at progression-free survival or overall survival versus a cancer specific outcome such as time to recurrence.
Table 1: Summary of the evidence regarding role of statins in the risk of endometrial cancer

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Table 2: Summary of evidence regarding statins and outcome of endometrial cancer

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It is vital to consider the duration of statin usage as well. In a recent meta-analysis by Liu et al.,[15] it was shown that when statins were taken for greater than 5 years, the risk of endometrial cancer was reduced by 31%. Moreover, they reported that studies conducted in Asian populations only had a significant relationship when all potential confounders were considered. It is important to note that patients who take statins tend to be elderly, have multiple comorbidities, and medication regimens including use of hormonal therapy; hence it is imperative to take these confounders into account.

These conflicting outcomes warrant further clinical investigation on the role of statins in endometrial cancer. We suggest that histological differentiation of endometrial cancer must also be analyzed in the future studies as different subtypes of endometrial cancer are closely linked with the prognosis. Moreover, randomized clinical trials are needed in this field urgently to eliminate selection, recall, and confounding bias inherent to observational studies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Lloyd-Jones DM, Goff D, Stone NJ. Statins, risk assessment, and the new American prevention guidelines. Lancet 2014;383:600-2.  Back to cited text no. 1
    
2.
National Cancer Institute; Surveillance, Epidemiology, and End Results Program. (Accessed July 1, 2015, at http://seer.cancer.gov/).  Back to cited text no. 2
    
3.
Nevadunsky NS, Van Arsdale A, Strickler HD, Spoozak LA, Moadel A, Kaur G, et al. Association between statin use and endometrial cancer survival. Obstet Gynecol 2015;126:144-50.  Back to cited text no. 3
    
4.
Yoon LS, Goodman MT, Rimel BJ, Jeon CY. Statin use and survival in elderly patients with endometrial cancer. Gynecol Oncol 2015;137:252-7.  Back to cited text no. 4
    
5.
Leung HW, Chan AL, Lo D, Leung JH, Chen HL. Common cancer risk and statins: A population-based case-control study in a Chinese population. Expert Opin Drug Saf 2013;12:19-27.  Back to cited text no. 5
    
6.
Lavie O, Pinchev M, Rennert HS, Segev Y, Rennert G. The effect of statins on risk and survival of gynecological malignancies. Gynecol Oncol 2013;130:615-9.  Back to cited text no. 6
    
7.
Jacobs EJ, Newton CC, Thun MJ, Gapstur SM. Long-term use of cholesterol-lowering drugs and cancer incidence in a large United States cohort. Cancer Res 2011;71:1763-71.  Back to cited text no. 7
    
8.
Haukka J, Sankila R, Klaukka T, Lonnqvist J, Niskanen L, Tanskanen A, et al. Incidence of cancer and statin usage - Record linkage study. Int J Cancer 2010;126:279-84.  Back to cited text no. 8
    
9.
Yu O, Boudreau DM, Buist DS, Miglioretti DL. Statin use and female reproductive organ cancer risk in a large population-based setting. Cancer Causes Control 2009;20:609-16.  Back to cited text no. 9
    
10.
Friedman GD, Flick ED, Udaltsova N, Chan J, Quesenberry CP Jr, Habel LA. Screening statins for possible carcinogenic risk: Up to 9 years of follow-up of 361, 859 recipients. Pharmacoepidemiol Drug Saf 2008;17:27-36.  Back to cited text no. 10
    
11.
Coogan PF, Rosenberg L, Strom BL. Statin use and the risk of 10 cancers. Epidemiology 2007;18:213-9.  Back to cited text no. 11
    
12.
Strandberg TE, Pyörälä K, Cook TJ, Wilhelmsen L, Faergeman O, Thorgeirsson G, et al.; 4S Group. Mortality and incidence of cancer during 10-year follow-up of the Scandinavian Simvastatin Survival Study (4S). Lancet 2004;364:771-7.  Back to cited text no. 12
    
13.
Kaye JA, Jick H. Statin use and cancer risk in the general practice research database. Br J Cancer 2004;90:635-7.  Back to cited text no. 13
    
14.
Clearfield M, Downs JR, Weis S, Whitney EJ, Kruyer W, Shapiro DR, et al. Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS): Efficacy and tolerability of long-term treatment with lovastatin in women. J Women's Health Gend Based Med 2001;10: 971-81.  Back to cited text no. 14
    
15.
Liu Y, Qin A, Li T, Qin X, Li S. Effect of statin on risk of gynecologic cancers: A meta-analysis of observational studies and randomized controlled trials. Gynecol Oncol 2014;133:647-55.  Back to cited text no. 15
    



 
 
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