title: Reduced esophageal cancer incidence in statin users, particularly with cyclo-oxygenase inhibition.
abstract: OBJECTIVE
  To examine the association between statin use and the development of esophageal cancer
  
  
  METHODS
  We performed a systematic review and meta-analysis. Multiple databases (Pubmed, EMBASE, Cochrane Library, Web of Science, Wiley Interscience and Google Scholar) were systematically searched for studies reporting the association of statin use and the development of esophageal cancer. Literature searching and data abstraction were performed independently by two separate researchers. The quality of studies reviewed was evaluated using the Newcastle-Ottawa Quality assessment scale. Meta-analysis on the relationship between statin use and cancer incidence was performed. The effect of the combination of statin plus a cyclo-oxygenase inhibitor was also examined.
  
  
  RESULTS
  Eleven studies met eligibility criteria, 9 high and 2 medium quality. All were observational studies. Studies examining adenocarcinoma development in Barrett's esophagus included 317 cancers and 1999 controls, population-based studies examining all esophageal cancers included 371203 cancers and 6083150 controls. In the Barrett's population the use of statins (OR = 0.57; 95%CI: 0.43-0.75) and cyclo-oxygenase inhibitors (OR = 0.59; 95%CI: 0.45-0.77) were independently associated with a reduced incidence of adenocarcinoma. Combined use of a statin plus cyclo-oxygenase inhibitor was associated with an even lower adenocarcinoma incidence (OR = 0.26; 95%CI: 0.1-0.68). There was more heterogeneity in the population-based studies but pooled adjusted data showed that statin use was associated with a lower incidence of all combined esophageal cancers (OR = 0.81; 95%CI: 0.75-0.88).
  
  
  CONCLUSIONS
  Statin use in patients with Barrett's oesophagus is associated with a significantly lower incidence of adenocarcinoma. The chemopreventive actions of statins, especially combined with cyclo-oxygenase inhibitors deserve further exploration.
authors.affiliation: Ian Leonard Phillip Beales, Department of Gastroenterology, Norfolk and Norwich University Hospital, Norwich NR4 7UY, United Kingdom.
authors.forename: Ian Leonard Phillip
authors.initials: IL
authors.lastname: Beales
authors.forename: Abigail
authors.initials: A
authors.lastname: Hensley
authors.forename: Yoon
authors.initials: Y
authors.lastname: Loke
keywords: Aspirin; Barrett’s oesophagus; Cancer risk; Chemoprevention; Esophageal carcinoma; Non-steroidal anti-inflammatory drugs; Statins
references.citation: Am J Epidemiol. 2008 Aug 1;168(3):237-49
references.pmid: 18550563
references.citation: Oncogene. 2010 Aug 19;29(33):4682-92
references.pmid: 20562912
references.citation: Gut. 2012 Jul;61(7):970-6
references.pmid: 21997553
references.citation: Aliment Pharmacol Ther. 2005 Feb 15;21(4):321-39
references.pmid: 15709983
references.citation: Am J Cardiol. 1990 Mar 15;65(11):767-71
references.pmid: 2316458
references.citation: J Natl Cancer Inst. 2005 Jan 19;97(2):142-6
references.pmid: 15657344
references.citation: Aliment Pharmacol Ther. 2008 Feb 15;27(4):316-20
references.pmid: 18062791
references.citation: Gastroenterology. 2003 Jan;124(1):47-56
references.pmid: 12512029
references.citation: Xenobiotica. 2003 Apr;33(4):379-88
references.pmid: 12745873
references.citation: Eur J Gastroenterol Hepatol. 2012 Aug;24(8):917-23
references.pmid: 22569083
references.citation: Dis Esophagus. 2012 Aug;25(6):535-44
references.pmid: 22129441
references.citation: Pharmacol Ther. 1999 Dec;84(3):413-28
references.pmid: 10665838
references.citation: BMC Cancer. 2011 Sep 26;11:409
references.pmid: 21943022
references.citation: J Thorac Cardiovasc Surg. 2011 Nov;142(5):1152-60
references.pmid: 22014341
references.citation: Am J Gastroenterol. 2005 Dec;100(12):2616-21
references.pmid: 16393209
references.citation: Recent Results Cancer Res. 2009;181:161-9
references.pmid: 19213566
references.citation: J Physiol Pharmacol. 2007 Aug;58 Suppl 3:141-8
references.pmid: 17901590
references.citation: Br J Cancer. 2009 Feb 10;100(3):551-7
references.pmid: 19156150
references.citation: Dis Esophagus. 2013 Nov-Dec;26(8):838-46
references.pmid: 22989236
references.citation: Lancet Oncol. 2005 Dec;6(12):945-52
references.pmid: 16321762
references.citation: Eur J Pharmacol. 2012 May 5;682(1-3):161-70
references.pmid: 22510296
references.citation: Am J Cardiol. 2004 Nov 1;94(9):1140-6
references.pmid: 15518608
references.citation: Gut. 1996 Jul;39(1):5-8
references.pmid: 8881798
references.citation: J Natl Cancer Inst. 2008 Aug 20;100(16):1184-7
references.pmid: 18695138
references.citation: Int J Cancer. 2010 Dec 15;127(12):2893-917
references.pmid: 21351269
references.citation: Aliment Pharmacol Ther. 2012 Dec;36(11-12):1105; author reply 1105-6
references.pmid: 23130778
references.citation: Gastroenterology. 2011 Mar;140(3):e18-52; quiz e13
references.pmid: 21376939
references.citation: Pharmacoepidemiol Drug Saf. 2008 Jan;17(1):27-36
references.pmid: 17944002
references.citation: Libyan J Med. 2012;7:
references.pmid: 22891079
references.citation: Clin Gastroenterol Hepatol. 2013 Jun;11(6):620-9
references.pmid: 23357487
references.citation: BMJ. 2010 May 20;340:c2197
references.pmid: 20488911
references.citation: Cancer Epidemiol Biomarkers Prev. 2012 Mar;21(3):456-61
references.pmid: 22241250
references.citation: Am J Gastroenterol. 2008 Apr;103(4):825-37
references.pmid: 18371146
references.citation: JAMA. 2000 Apr 19;283(15):2008-12
references.pmid: 10789670
references.citation: Am J Cardiol. 2006 Dec 4;98(11A):34P-41P
references.pmid: 17126678
references.citation: Clin Gastroenterol Hepatol. 2009 Dec;7(12):1299-304
references.pmid: 19523538
references.citation: N Engl J Med. 2013 Feb 7;368(6):576-7
references.pmid: 23388012
references.citation: Ann Intern Med. 2009 Jan 6;150(1):9-18
references.pmid: 19124815
references.citation: Cancer Sci. 2007 Jun;98(6):890-9
references.pmid: 17428261
references.citation: Expert Opin Drug Saf. 2010 Jul;9(4):603-21
references.pmid: 20377474
references.citation: Cancer Causes Control. 2007 Aug;18(6):585-93
references.pmid: 17406989
references.citation: Eur J Cancer Prev. 2009 Sep;18(5):381-4
references.pmid: 19620873
references.citation: N Engl J Med. 2011 Oct 13;365(15):1375-83
references.pmid: 21995385
references.citation: Cell Prolif. 2012 Dec;45(6):557-65
references.pmid: 23045963
references.citation: Gastroenterology. 2011 Dec;141(6):2000-8; quiz e13-4
references.pmid: 21878200
references.citation: Ann N Y Acad Sci. 2011 Sep;1232:210-29
references.pmid: 21950815
references.citation: Biochemistry. 2003 Apr 22;42(15):4384-91
references.pmid: 12693933
references.citation: Gastroenterology. 2010 Jun;138(7):2260-6
references.pmid: 20188100
references.citation: World J Gastroenterol. 2012 Jan 14;18(2):126-35
references.pmid: 22253518
references.citation: Int J Cancer. 2008 Mar 1;122(5):1118-29
references.pmid: 17990321
references.citation: Br J Cancer. 2004 Feb 9;90(3):635-7
references.pmid: 14760377
references.citation: Clin Gastroenterol Hepatol. 2010 Mar;8(3):235-44; quiz e32
references.pmid: 19850156
references.citation: Cancer. 2001 Aug 1;92(3):549-55
references.pmid: 11505399