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June 21, 2006

Statins and the Risk of Cancer

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295(23):2720-2722. doi:10.1001/jama.295.23.2721-a

To the Editor: We are concerned that in the meta-analysis of statin use and cancer by Dr Dale and colleagues1 the periods of follow-up and of statin use in the randomized controlled trials (RCTs) are too brief to have captured a true association between statin use and cancer risk or mortality. For prostate cancer and several other cancers analyzed in the meta-analysis, there is a well-recognized and often extended latency time between the initiation of cancer and clinical detection.2 Although the median age at initial prostate cancer diagnosis is 69 years in the United States,3 autopsy studies have shown that prostatic intraepithelial neoplasia, a potential premalignant precursor, and histologic prostate cancer are evident in the third and fourth decades of life.4,5 Thus, the critical period of cancer initiation likely occurred long before the time period evaluated in the statin RCTs for most of the prostate cancers observed in RCT participants. The follow-up period in almost 90% of the meta-analysis RCTs was 5 years or less. This relatively short time frame, particularly with regards to prostate cancer, makes it highly unlikely that the short-term statin use evaluated in the RCTs would have affected the incidence of cancer.