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Association between statin use and second cancer risk in breast cancer patients: a nationwide population-based cohort study

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Many studies have revealed that statin therapy reduced mortality in cancer patients, especially in breast cancer, but the effect for second cancer was unclear. We, therefore, performed a comparable cohort study to determine the risk of second cancer in breast cancer patients with statin therapy.

Methods

Using claims data from Taiwan’s National Health Insurance Program, this study enrolled newly diagnosed breast cancer patients from 2000 to 2007 with and without statin therapy as the statin (n = 1222) and nonstatin (n = 4888) cohorts, respectively. The nonstatin cohort was propensity score matched by cohort entry year, age, and randomly selected comorbidities. These two cohorts were followed up until the diagnosis of second cancer, death, or the end of 2011. Cox proportional hazard models were used to estimate the hazard ratios.

Results

The statin cohort had a lower incidence rate than the nonstatin cohort for second cancer (7.37 vs. 8.36 per 1000 person-years), although the difference was not significant (adjusted hazard ratio [aHR] 0.90, 95% confidence interval [CI] 0.65–1.26). Compared with the nonstatin cohort, the second cancer risk was significantly higher for patients taking pravastatin (aHR 2.71, 95% CI 1.19–6.19) but lower for those receiving multiple statin treatment (aHR 0.45, 95% CI 0.25–0.81) and combined lipophilic and hydrophilic type of statin (aHR 0.42, 95% CI 0.20–0.89). The risk was lower for patients receiving a cumulative defined daily dose (cDDD) of > 430 (aHR 0.41, 95% CI 0.19–0.86).

Conclusion

This study showed that there is little association between statin use and second cancer risk in breast cancer patients.

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Data availability

The NHIRD is held by the Taiwan Ministry of Health and Welfare. Any researcher interested in accessing the data set can submit an application form to the Ministry of Health and Welfare requesting access.

Abbreviations

cDDD:

Cumulative defined daily dose

CI:

Confidence interval

ICD-9-CM:

International Classification of Disease, Ninth Revision, Clinical Modification

NHIRD:

National Health Insurance Research Database

RCIPD:

Registry of Catastrophic Illness Patient Database

SHR:

Subdistribution hazard ratio

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Acknowledgements

The authors thank Dr. Yu-Fen Li for her help with the analysis of the NHIRD.

Funding

This research was funded by the China Medical University (CMU107-N-23), Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW109-TDU-B-212-114004), MOST Clinical Trial Consortium for Stroke (MOST 108-2321-B-039-003-), Ditmanson Medical Foundation Chia-Yi Christian Hospital (Grant No. R105-024), and Tseng-Lien Lin Foundation, Taichung, Taiwan.

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Author notes

  1. Yin-Che Lu and Da-Wei Huang contributed equally to this work.

Authors and Affiliations

  1. Division of Hematology-Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-yi, Taiwan

    Yin-Che Lu & Pin-Tzu Chen

  2. Min-Hwei Junior College of Health Care Management, Tainan, Taiwan

    Yin-Che Lu

  3. Section of Neurosurgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-yi, Taiwan

    Da-Wei Huang

  4. Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-yi, 600, Taiwan

    Ching-Fang Tsai

  5. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Mei-Chen Lin & Che-Chen Lin

  6. School of Medicine, China Medical University, Taichung, Taiwan

    Mei-Chen Lin, Che-Chen Lin & Yi-Jiun Pan

  7. Department of Occupational Safety and Health, China Medical University, Taichung, Taiwan

    Shi-Heng Wang

  8. Department of Public Health, China Medical University, Taichung, Taiwan

    Shi-Heng Wang

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Contributions

YCL, DWH, SHW, and YJP contributed to conceptualization, methodology, and investigation; PTC, CFT, MCL, and CCL contributed to software and formal analysis; SHW and YJP contributed to validation, supervision, project administration, and writing—review and editing; CFT, MCL, and CCL contributed to resources and data curation; PTC and CFT contributed to visualization; and YCL and DWH contributed to writing—original draft preparation. All the authors read and approved the final manuscript.

Corresponding authors

Correspondence to Shi-Heng Wang or Yi-Jiun Pan.

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The authors declare no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The studies are in accordance to the institutional guidelines for clinical research under IRB approved protocol (CMUH-104-REC2-115-R4) by the Research Ethics Committee of China Medical University for this retrospective study.

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Lu, YC., Huang, DW., Chen, PT. et al. Association between statin use and second cancer risk in breast cancer patients: a nationwide population-based cohort study. Breast Cancer Res Treat 185, 773–783 (2021). https://doi.org/10.1007/s10549-020-05969-9

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