The commonly used prescription statin drugs may have a protective effect in the prevention of liver cancer and lead to a reduction in the need for gallbladder removals, according to two studies published in Gastroenterology. As millions of Americans use statins each day to help lower their cholesterol and risk of heart disease, researchers are learning of the beneficial effects these drugs may have on gastrointestinal disorders. Gastroenterology is the official journal of the American Gastroenterological Association (AGA) Institute.

Statins Benefit Diabetics at High Risk of HCC

Statin use is associated with a significant reduction in the risk of hepatocellular carcinoma (HCC), or liver cancer, among patients with diabetes, according to a new study in Gastroenterology.

“Our study provides the first indication of a cancer preventive effect for statins specific to HCC,” said Hashem B. El-Serag, MD, MPH, of the Baylor College of Medicine and lead author of the study. “While these findings need to be confirmed in future studies, we are hopeful that further research continues to show the beneficial effect of statins for liver cancer prevention in patients with diabetes.”

HCC is a highly fatal malignancy that has been increasing in several regions of the world, including the U.S. Experimental as well as indirect human data suggests that statins exert a beneficial action, reducing the progression of HCC.

Researchers undertook an epidemiological study in a large cohort of diabetics, whose risk of HCC was higher than average, to characterize the relationship between statin use and HCC and other liver disease. The team examined 1,303 cases and 5,212 controls; the mean age was 72 years. Ninety-nine percent were men and 13 percent were African Americans. A significantly smaller proportion of cases (34.3 percent) had at least one filled prescription for statins than controls (53.1 percent).

The research team found a significant inverse association between having statin prescriptions filled and the risk of developing HCC. There was a trend toward stronger risk reduction with longer and more frequent statin prescriptions. The risk reduction observed with statins ranged between 25 percent and 40 percent. Reduced HCC risk was similar, whether the prescriptions were for simvastatin or any other statin dispensed.

Statins May Reduce Risk of Gallbladder Removal Surgery

The use of statins appears to reduce the risk of cholecystectomy, surgical removal of the gallbladder, in women, according to a new study in Gastroenterology.

Gallstone disease is a common abdominal condition in developed countries and is a major cause of digestive disease leading to hospital admissions. In the U.S., more than 800,000 cholecystectomies are performed each year.

Researchers examined the relationship between statin use and the risk of cholecystectomy in a cohort of U.S. women participating in the prospective Nurses’ Health Study. Participants biennially reported their health history, including incidence of gallstone disease and whether they had undergone cholecystectomy.

Researchers conducted a retrospective analysis of statin use through data collected in 2000 to define use from 1994 forward, and a prospective analysis for general lipid-lowering drugs from 1994 to 2004. In the statin analysis, the researchers ascertained 2,479 cases of cholecystectomy during 305,197 person-years of follow-up. The multivariate relative risk for current statin users, compared with nonusers, was 18 percent. In the analysis of general cholesterol-lowering drugs, researchers ascertained 3,420 cases of cholecystectomy during 511,411 person-years of follow-up. Compared with nonusers, the multivariate relative risk for current users of general cholesterol-lowering drugs, mostly statins in this cohort, was 12 percent. Among diabetic women, duration of current statin use was correlated with risk of cholecystectomy. Compared with statin nonuse, the relative risk for current statin use of two or more years was 75 percent.

“Further study, particularly among diabetics, is warranted to evaluate the associations of longer durations of statin use and specific types of statins with risk,” said Chung-Jyi Tsai, MD, of the University of Kentucky Medical Center and lead author of the study. “Our results should have implications for additional clinical, epidemiological and mechanistic research.”

Source:
Alissa Cruz

American Gastroenterological Association

In the U.S., more than 180,000 women are diagnosed with invasive breast cancer each year. Many of these women will undergo mastectomy surgery that will result in disfiguring scars because they are unaware of the availability of skin-sparing mastectomies and did not ask their surgeons about this treatment option. Skin-sparing mastectomy is a surgical technique to remove cancerous breast tissue by using the same minimal and judiciously placed incisions used by plastic surgeons for elective breast surgery.

Despite the availability of skin-sparing mastectomies, a recent California study published in The American Surgeon found that more than one-third of board-certified breast surgeons surveyed still regularly use the archaic practice of cutting across the whole breast, resulting in unnecessarily disfiguring scars even after breast reconstruction.

“Amidst the shock and anxiety of a breast cancer diagnosis, many women and some physicians consider the appearance of the breasts of secondary importance and not worthy of serious consideration compared to the treatment of cancer,” said Joel Aronowitz, M.D., Clinical Chief of Plastic Surgery at Cedars Sinai Medical Center and founder of the Breast Preservation Foundation, a non-profit organization dedicated to increasing awareness and educating women and their caregivers about skin-sparing mastectomy.

“We know that skin sparing and old style transverse mastectomy techniques are equal in effectiveness as cancer treatments. Therefore, every woman has a right to be informed about choices in mastectomy surgery that improve the cosmetic appearance of the breast and be able to consider all options before embarking on major surgery that will impact their overall quality of life.”

The skin-sparing technique uses a simple, small, circular incision around the edge of the nipple area. The surgeon leaves all or most of the overlying breast skin, preserving the natural skin envelope that can be filled with an implant or with a patient’s own fat tissue from another part of the body. This skin-sparing technique is appropriate for women whose breast cancer does not invade the skin of the breast and particularly when immediate reconstruction is planned.

Millions of women have benefited from elective breast surgery by plastic surgeons over the past 60 years to correct congenital deformity and improve size and shape to enhance women’s lives. Great strides have been made in the understanding of breast surgery and now the medical profession is beginning to apply these advances to one of the most dreaded of operations - mastectomy.

Today, effective mastectomy can be performed with far better cosmetic results. Since new breast cancer cases are among the highest rates ever recorded and breast cancer survival rates are also on the rise it is necessary for patients and their physicians to consider what treatment options will positively affect the patients’ overall health, healing and quality of life, post cancer.

As the senior author in The American Surgeon study and founder of the Breast Preservation Foundation, Dr. Aronowitz hopes to also persuade the general surgery community to use plastic surgery principles for placement of incisions for biopsy and mastectomy procedures.

“Increased use of these modern, reconstructive surgery concepts will result in a decreased use of standard, centuries old ‘cut across the chest’ incisions causing severe disfigurement and long-lasting emotional distress for cancer patients. These are the most modern aesthetic techniques and principles that can be applied with the same rigor as is given to the treatment of cancer, and combined can result in a more satisfying outcome,” Dr. Aronowitz added.

For more information about skin-sparing mastectomies, breast cancer survival and the Breast Preservation Foundation, please visit http://www.BreastPreservation.org.

Source
Breast Preservation Foundation

TORONTO, May 12 — Despite treatment, women diagnosed with cervical intraepithelial neoplasia (CIN) remain at higher risk for a recurrence of the disease or invasive cervical cancer, an international team of researchers said.

• Explain to interested patients that this study found that cervical intraepithelial neoplasia (CIN) treatment does not rule out the prospect of recurrent disease or even invasive cervical cancer.
• Caution that the finding is based on a retrospective cohort analysis and needs to be confirmed.

In a retrospective cohort study, the risk of a subsequent diagnosis of CIN2/3 was associated with the initial diagnosis, age at diagnosis, and treatment method, according to Joy Melnikow, M.D., of the University of California Davis, and colleagues.

Importantly, the rate of invasive cervical cancer was about six times higher among women with a previous diagnosis of CIN than among those without abnormal cytology, Dr. Melnikow and colleagues said online in the Journal of the National Cancer Institute.

“We now have a much more clear idea of the risks of recurrent abnormal cells and invasive cervical cancer over time after treatment of these cells,” Dr. Melnikow said in a statement.

The researchers studied records of 37,142 women treated for CIN 1, 2, or 3 from Jan. 1, 1986, through Dec. 31, 2000 from the British Columbia Cancer Agency cytology database. They linked those records with cancer registry and vital statistics data.

The women were treated with cryotherapy, loop electrosurgical excision procedures, cone biopsy, or laser vaporization or excision.

The so-called CIN cohort was compared with 71,213 women with normal cytology and no CIN diagnosis. All the women in the study were followed until Dec. 31, 2004.

In the first six years after treatment, Dr. Melnikow and colleagues found, the cumulative rate of CIN 2/3 was:

• 14.0% for women originally treated for CIN 3
• 9.3% for women treated for CIN 2
• 5.6% for women treated for CIN 1

Rates of CIN 2/3 were higher for those diagnosed with CIN 3, compared with those who had a lower stage of disease. They were also higher for women diagnosed when they were 40 or older and for those treated with cryotherapy.

After six years, the annual rates of CIN 2/3 were less than 1%, regardless of original diagnosis, and comparable to rates seen among the comparison cohort, the researchers said.

The overall incidence of invasive cancer per 100,000 woman-years was 37 in the CIN cohort, compared with 6.0 in the comparison group.

The same three factors were also associated with increased risk:

• Women treated with cryotherapy, compared with other modalities, had an odds ratio for cancer of 2.98 (CI 2.09 to 4.26).
• Those whose initial diagnosis was CIN 3 (compared with CIN 1 or 2) had an odds ratio of 4.10 (CI 2.70 to 6.22).
• Women 40 or older had an odds ratio of 1.75 (CI 1.12 to 2.74) compared to younger women.

“These data may help inform that treatment discussion, because we know more about how age and different treatments appear to influence risks,” Dr. Melnikow said.

The study was limited by its retrospective design, the researchers said. Also, they were unable to account for changing treatment patterns over the study period.

The findings suggest the need for long-term surveillance of women with a diagnosis of CIN even after treatment, according to Edward Wilkinson, M.D., of the University of Florida College of Medicine in Gainesville, Fla.

In an accompanying editorial, Dr. Wilkinson said the results “support evidence that active surveillance has value in identifying the majority of the high-grade CIN lesions and cervical carcinomas.”

One implication of the study, he said, is that some apparently recurrent CIN may be persistence of disease, rather than a true recurrence.

“In the CIN 3 group,” he said, “the possibility of a persistent lesion, rather than a true recurrence of a new lesion, is supported by the finding that the majority of women with lesions that were found during surveillance after therapy were found within the first two years after therapy.”

The study was supported by the National Cancer Institute. The researchers reported no conflicts. Dr. Wilkinson reported financial links with Merck and Guided Therapeutics.

Primary source: Journal of the National Cancer Institute

Source reference:

Melnikow J, et al “Cervical intraepithelial neoplasia outcomes after treatment: Long-term follow-up from the British Columbia Cohort Study” J Natl Cancer Inst 2009; 101: 721-28

Additional source: Journal of the National Cancer Institute

Source reference:

Wilkinson EJ “Women with cervical intraepithelial neoplasia: requirement for active long-term surveillance after therapy” J Natl Cancer Inst 2009; 101: 696-97.