title: Statins and breast cancer prognosis: evidence and opportunities.
abstract: Much preclinical and epidemiological evidence supports the anticancer effects of statins. Epidemiological evidence does not suggest an association between statin use and reduced incidence of breast cancer, but does support a protective effect of statins--especially simvastatin--on breast cancer recurrence. Here, we argue that the existing evidence base is sufficient to justify a clinical trial of breast cancer adjuvant therapy with statins and we advocate for such a trial to be initiated without delay. If a protective effect of statins on breast cancer recurrence is supported by trial evidence, then the indications for a safe, well tolerated, and inexpensive treatment can be expanded to improve outcomes for breast cancer survivors. We discuss several trial design opportunities--including candidate predictive biomarkers of statin safety and efficacy--and offer solutions to the key challenges involved in the enrolment, follow-up, and analysis of such a trial.
authors.affiliation: Departments of Surgery and Biochemistry, University of Vermont College of Medicine, Burlington, VT, USA. Electronic address: thomas.ahern@med.uvm.edu.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Ahern
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Lash
authors.affiliation: Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Damkier
authors.affiliation: Unit of Breast and Endocrine Surgery, Aarhus University Hospital, Aarhus, Denmark; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark.
authors.forename: Peer M
authors.initials: PM
authors.lastname: Christiansen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Deirdre P
authors.initials: DP
authors.lastname: Cronin-Fenton
mesh_terms: D001943:Breast Neoplasms / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011379:Prognosis; D055502:Secondary Prevention / Q000379:methods*; D012680:Sensitivity and Specificity
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors