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Statin Cholesterol Drugs and Invasive Breast Cancer

Reducing cholesterol levels may inhibit breast cancer development, but the long-term use of cholesterol-lowering statin drugs is associated with more than double the risk of both types of breast cancer: invasive ductal carcinoma and invasive lobular carcinoma.

April 28, 2014 |
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Supplementary Info

Sources Cited

AB Awad, SL Barta, CS Fink, PG Bradford. Beta-Sitosterol enhances tamoxifen effectiveness on breast cancer cells by affecting ceramide metabolism. Mol Nutr Food Res. 2008 52(4):419 – 426.

K Undela, V Srikanth, D Bansal. Statin use and risk of breast cancer: A meta-analysis of observational studies. Breast Cancer Res Treat. 2012 135(1):261 – 269.

JA McDougall, KE Malone, JR Daling, KL Cushing-Haugen, PL Porter, CI Li. Long-term statin use and risk of ductal and lobular breast cancer among women 55 to 74 years of age. Cancer Epidemiol.

CM Kitahara, AB de González, ND Freedman, R Huxley, Y Mok, SH Jee, JM Samet. Total cholesterol and cancer risk in a large prospective study in Korea. J Clin Oncol. 2011 29(12):1592 – 1598.

YC Li, MJ Park, SK Ye, CW Kim, YN Kim. Elevated levels of cholesterol-rich lipid rafts in cancer cells are correlated with apoptosis sensitivity induced by cholesterol-depleting agents. Am J Pathol. 2006 168(4):1107 – 18; - quiz - 1404 – 5.

C Danilo, PG Frank. Cholesterol and breast cancer development. Current Opinion in Pharmacology. 2012 12(6):677–682.

AS Kumar, LJ Esserman. Statins: Health-promoting agents show promise for breast cancer prevention. Clin Breast Cancer. 2005 6(5):455 – 459.

DJA Jenkins, CWC Kendall, A Marchie, AL Jenkins, PW Connelly, PJH Jones, V Vuksan. The Garden of Eden--plant based diets, the genetic drive to conserve cholesterol and its implications for heart disease in the 21st century. Comp Biochem Physiol, Part A Mol Integr Physiol. 2003 136(1):141 – 151.

H Rosenberg, D Allard. Women and statin use: a women's health advocacy perspective. Scand Cardiovasc J. 2008 Aug;42(4):268-73.

Acknowledgements

Transcript

What does breast cancer have to do with cholesterol? Here are some of the potential mechanisms by which cholesterol boosts breast cancer growth. Cholesterol is what our body makes estrogen out of, it’s packaged into LDL, which we saw appeared to increase proliferation and decrease patient survival, and it’s a major component of lipid rafts.

Compared with their normal counterparts, cancer cells have higher levels of cholesterol-rich lipid rafts in their plasma membrane, which may be important for cancer cell survival, as well as serve in human cancer development in terms of tumor migration and invasion.

Elevated levels of cholesterol-rich lipid rafts have been found in breast cancer cells, and the thought is that reducing blood cholesterol levels may disrupt lipid raft formation and thereby inhibit breast cancer development. This suggests cholesterol targeting may be used as a cancer therapy.

Controlled laboratory experiments have shown that phytosterols in seeds and nuts at dietary relevant levels appear to inhibit the growth of several types of tumor cells including breast cancer cells, both estrogen-receptor negative and estrogen-receptor positive cancer.

The therapeutic implications are that plant-based diets rich in phytosterols may offer protection against the development of breast cancer. Of course you can’t make a lot of money on pumpkin seeds, so researchers looked to cholesterol-lowering statin drugs.

However, evaluating the safety of statin therapy for women is particularly difficult. Little research has explicitly proceeded from a gender-based perspective. Some petri dish work looked promising, but population studies have shown mixed results. Some studies showed that women on statins had decreased breast cancer risk, some showed increased risk, and most showed no association. But these were all relatively short-term studies. So-called “long-term” statin use was defined as mostly just three to five years. Breast cancer can take decades to grow. The one study that looked at ten or more years of statin use only included 62 cases. Given the increase in statin use over the past few decades, and the fact that they’re commonly prescribed to be taken every day for the rest of people’s lives, the studies published to date have had limited ability to evaluate the impact of long durations of use. And we better figure this out. About one in four women over 45 in this country are on these drugs. But that was the only data we had, until now.

Thousands of breast cancer cases included, and long term statin users—women taking statins for ten years or more, had more than double the risk of both types of breast cancer: invasive ductal carcinoma and invasive lobular carcinoma.

Now, the number one killer of women is heart disease, not breast cancer, so we still need to bring down cholesterol levels. If only there was a way to get the pros with out the cons. Plant-based diets have been shown to lower LDL-cholesterol by over 30%, within just a couple weeks, equivalent to most of the standard cholesterol lowering statin drugs without any known breast cancer risk.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Ariel Levitsky.

To help out on the site please email volunteer@nutritionfacts.org.

Dr. Michael Greger

Doctor's Note

If you missed the “prequel” video you might be confused about the role cholesterol plays in breast cancer risk. Watch Cholesterol Feeds Breast Cancer Cells.

Though as drugs go, statins are remarkably safe, they can present rare but serious side effects in both men and women: Statin Muscle Toxicity.

How can we lower cholesterol without drugs? It’s Purely a Question of Diet. We can lower our cholesterol by lowering our intake of three things: Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero. Where are trans fats found? Trans Fat In Meat And Dairy. Where is cholesterol found? Predominantly eggs: Eggs and Cholesterol: Patently False and Misleading Claims. There are also some foods adept at lowering cholesterol levels:

 If you haven't yet, you can subscribe to my videos for free by clicking here.

  • Roseveg

    Is eating raw corn-on-the-cob harmful? I see that corn is a grain, and grains I suppose are to be cooked in order to deal with anti-nutrients/natural toxins, but raw corn on the cob is so easy and delicious to eat, but I am wondering if it is harmful unless cooked. Sort of like how there are things in certain beans and other grains that will cause harm to humans unless the beans are cooked, neutralizing a few things). As far as digestion goes, I do fine with raw corn.

    • Julot Julott

      We can only digest a small amount of raw starch.

  • Anenys

    Thank you for the video, a topical issue indeed. What would you recommend if a strictly vegan, fruit-and-veg based diet and regular exercise are not enough to bring the blood cholesterol down to desired levels? I.e. girls/women living with inherited familial hypercholesterolemia?

  • Amy

    I have these same two questions!

  • Plantstrongdoc M.D.

    Statins are potent drugs, with potentially dangerous side effects, and should – as every other pharmaceutical drug – be used with caution. Too many people are on statins – the only thing they will experience are side effects -and some deadly – and no benefit.

    • VegAtHeart

      FYI: this article just published Apr. 24th in NEJM summarizes positions on statin use as primary prevention.

  • DGH

    I am skeptical that statins actually promote cancer in the long-term. We do have some long-term follow-up of randomized trials, such as the Heart Protection Study and the West of Scotland Coronary Prevention Study, which show no increased risk of malignancy with these lifesaving drugs. The individual patient data meta-analyses by the Cholesterol Treatment Trialists Collaboration also indicate no increased risk for cancer, and possible protection. Therefore to indict these drugs based on observational studies, which are heavily prone to selection bias (i.e. higher risk women are put on statins in the first place) and residual confounding (i.e. covariates that are not measured and cannot be adjusted for) – is likely a spurious fallacy.

    • Darryl

      The cited study only adjusted for year and age when diagnosed, residence, and history of hormone replacement therapy. Other known risk factors, common to both cardiovascular disease and breast cancer (like obesity, diet, and exercise) weren’t considered.

      It’s possible we’re seeing the effects of a common cause for both diagnosable invasive breast cancer, and 10 years use of statins by age 55-74. This website offers a lot of suspects.

  • brec

    “more than double the risk of both types of breast cancer” … Doc, when you think of it and it’s convenient, in these kind of reports would you also mention the absolute risk measures along with relative?

    • Darryl

      The cited paper, a retrospective case-control study, because of its design, couldn’t report the absolute risks for its population. The lifetime risk (by age 90) for invasive breast cancer incidence from this 1993 study was 12.1%. According to Wikipedia, Invasive ductal carcinoma accounts for 55% of invasive breast cancer, while invasive lobular accounts for 5-10%. So lifetime risks for these two types could be around 6.7% and 0.6-1.2% respectively. Before the statins, at least.

    • Birt

      Thanks for requesting that. I frequently want to see that too. Helps to make more independent decisions.

  • Becca

    Rosewing, Some farmers are genetically engineering sweet corn to not only create their own pesticide in the gut of the consumer, but to also be resistant to Roundup. This means that the crop won’t die, but the chronic effects to people and animals are another story.
    Don’t eat sweet corn unless it is certified organic. Then, only sparingly.

    • Derby City Vegan

      Becca, farmers do not have the resources to genetically engineer crops. Large corporations such as Monsanto and DuPont do. So-called Bt modified corn does form toxins in the guts of target pests. However, due to the lower pH of the human gut, these toxins are not formed in humans. Bacillus thuringiensis (Bt) has long been used to protect certain crops instead of synthetic pesticides. Although I remain skeptical of GM crops, the alarm you have sounded about Bt modified corn is most likely unfounded.

      Finally a question – what evidence can you provide that certified organic corn should be eaten only sparingly?

      • Susan

        I stand corrected. Poor wording on my post. Of course, farmers are not genetically modifying crops. But, many are using genetically engineered seeds from Monsanto, Dupont, Syngenta, Bayer, Dow and others to change the dna of seeds so that the corporations can sell more of their highly toxic herbicides with LESS regulation and government oversight to kill superweeds which has popped up from constant spraying. And, now, because of more superweeds, the corporations are genetically engineering the seeds in triplicate so that the seeds can basically drink 3 different weed killers and not die.
        However, the runoff from the fields is highly toxic, poisoning fish and livestock/wildlife that drink the waters, the drift from the fields is in the air and is cleansed from the clouds and sky when it precipitates –it’s raining pesticides containing 100% Round-up, 2,4-D and other pesticides, and may be contaminating organic backyards and fields. And remember, that organic livestock, while not intentionally fed GMO corn and soy, may be getting it in organic feed, UNLESS they are pastured and graze on grasses (inc. alfalfa) that is not yet contaminated. But, wildlife and livestock still drink unpurified waters. Hence, this is a good reason to eat vegan!
        Monsanto is coming out with genetically engineered sweet corn this year, which is why I recommend eating certified organic corn sparingly. One never knows when the corn or soy you are eating is contaminated, as I learned when I consumed a small amount of certified organic soymilk on my cereal and received my first super bad case of indigestion. It was not used by the farmer, but was contaminating their field, compliments of Monsanto. The effects to me was the same.

  • VegAtHeart

    This 2014 cochrane review summarizing the results of 18 randomized control trials on statin use concluded that statins are effective in primary prevention of cardiovascular disease and do not increase risk of “serious adverse effects” such as cancer.

  • Linda

    Has anyone seen the video/film Statin Nation? If so, what was your opinion?

  • Sam

    Cholesterol has important function in the body, does it not? isn’t it a precursor to many hormones and other important functions? and reducing dietary cholesterol would not significantly benefit, even if our cells manufacture it? why isn’t cholesterol seen as a protective agent rather then concluding that at the site of the problem there is cholesterol in tumor cells, in the arteries and so on?