Abstract
PurposePrior studies conducted primarily in white populations have suggested that pre-diagnostic cholesterol lowering drugs (CLDs) improved survival among women with breast cancer (BC). However, this association had not been well characterized in diverse racial/ethnic populations. We investigated whether pre-diagnostic CLD use is associated with all-cause and BC-specific mortality among female BC cases of the Multiethnic Cohort (MEC).MethodsCLD use was ascertained through questionnaires administered in 2003–2008. A total of 1448 incident BC cases were identified by linkage to SEER cancer registries in Hawaii and California from 2003 to 2014. Multivariable Cox regression was conducted to estimate hazard ratios (HR) and 95% confidence intervals (CI) of the associations of pre-diagnostic CLD use with all-cause and BC-specific mortality, adjusting for tumor characteristics, first course of treatment, health behaviors, co-morbidities, and demographics. Subgroup analyses by stage and hormone receptor status were conducted for all-cause mortality.ResultsThere were 224 all-cause and 87 BC-specific deaths among the 1448 BC cases during a median follow-up of 4.5 years after diagnosis. Women with BC who ever used CLDs had a 27% lower hazard of all-cause mortality (HR 0.73, 95% CI 0.54–0.98) and 17% lower hazard of BC-specific mortality (HR 0.83, 95% CI 0.49–1.39) compared to never users. CLD use reduced mortality among women with advanced-stage tumors and hormone receptor-positive breast tumors (HR 0.54 95% CI 0.33–0.90; HR 0.69, 95% CI 0.48–0.99, respectively).ConclusionThese findings demonstrate an improved survival associated with CLD use prior to diagnosis in a multiethnic population of women with BC.
Highlights
Breast cancer is the most commonly diagnosed cancer among women in the United States, and advances in disease management and the promotion of breast cancer screening have improved the survival rates of breast cancer
Our final study population consisted of 1448 breast cancer cases (54.8% never users, 6.7% past users, and 38.5% current users of cholesterol lowering drugs)
Compared to never-users, breast cancer cases who reported having ever used cholesterol lowering drugs prior to diagnosis had a 27% lowered hazard of all-cause mortality (HR 0.73, 95% confidence intervals (CI) 0.54–0.98, Table 2)
Summary
Breast cancer is the most commonly diagnosed cancer among women in the United States, and advances in disease management and the promotion of breast cancer screening have improved the survival rates of breast cancer. Several epidemiologic cohort studies have shown that use of cholesterol lowering drugs confers benefit on allcause and breast cancer-specific mortality among breast cancer cases [15–20]. In the largest cohort study to date, conducted among 20,559 Swedish women with breast cancer, Borgquist et al reported all-cause mortality hazard ratios of 0.76 (95% CI 0.66–0.88) and 0.89 (95% CI 0.82–0.96) for pre-and post-diagnostic statin use, respectively, compared to never users. The HRs for breast cancerspecific mortality was 0.77 (95% CI 0.63–0.95) and 0.83 (95% CI 0.75–0.93) for pre- and post-diagnostic statin use, respectively, compared to never users [19]. The majority of studies on the association between statins and breast cancer outcomes were conducted among cohorts of Scandinavian and Western European women [15–19, 21, 22]
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