Statin use and patterns of breast cancer recurrence in the Malmö Diet and Cancer Study

Maria Inasu; Maria Feldt; Helena Jernström; Signe Borgquist; Sixten Harborg

doi:10.1016/j.breast.2022.01.003

Statin use and patterns of breast cancer recurrence in the Malmö Diet and Cancer Study

Breast. 2022 Feb:61:123-128. doi: 10.1016/j.breast.2022.01.003. Epub 2022 Jan 4.

Authors

Maria Inasu¹, Maria Feldt², Helena Jernström², Signe Borgquist³, Sixten Harborg⁴

Affiliations

¹ Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden. Electronic address: maria.inasu@med.lu.se.
² Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
³ Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Oncology, Aarhus University/Aarhus University Hospital, Denmark.
⁴ Department of Oncology, Aarhus University/Aarhus University Hospital, Denmark. Electronic address: sixten.harborg@oncology.au.dk.

Abstract

Background: Accumulating evidence suggests that statins have a beneficial effect on breast cancer prognosis. Previous studies have reported a positive association between statin use and breast cancer survival; however, the relationship between statin use and patterns of breast cancer recurrence remains unclear.

Patients and methods: We identified all Malmö Diet and Cancer Study (MDCS) participants diagnosed with incident invasive breast cancer between 2005 and 2014. The follow-up period began at breast cancer diagnosis and continued until the first invasive breast cancer recurrence event, death, emigration or the end of the follow-up (June 8, 2020). We estimated incidence rates (IRs) of recurrence and fit Cox regression models to compute crude and adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) for disease recurrence to compare post-diagnosis statin users with non-users.

Results: The final study cohort consisted of 360 eligible patients with a median follow-up of 8.6 years. Overall, there were 71 recurrences in 2932 total person-years. According to statin use, there were 14 recurrences in 595 person-years among statin users, and 57 recurrences in 2337 person-years in non-users. Statin use was associated with a reduced risk of breast cancer recurrence (HR_adj = 0.88 [95% CI: 0.82-0.96]). Regarding the pattern of recurrence, statin use was associated with a reduced risk of distant recurrence (HR_adj = 0.86 [95% CI: 0.80-0.94]) but not loco-regional recurrence (HR_adj = 0.97 [95% CI: 0.87-1.08]).

Conclusion: In the MDCS, statin use was associated with a reduced risk of distant breast cancer recurrence, whereas no association between statin use and loco-regional breast cancer recurrence was found. This site-based difference in disease recurrence may be explained by statin's inhibition of epithelial-mesenchymal transition.

Keywords: Breast cancer; Cholesterol; Distant recurrences; Recurrence; Statins.

MeSH terms

Breast Neoplasms* / epidemiology
Diet
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
Neoplasm Recurrence, Local / epidemiology
Proportional Hazards Models

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors