Breast Cancer, Heart Disease, and Whispering “Fire” in a Public Theater
Couplée à un essai randomisé incluant 4 690 participantes et portant sur 279 cas et 558 témoins, cette étude évalue l'association entre le niveau sérique de lipides et de lipoprotéines et le risque de cancer du sein
In this issue of the Journal, Martin and colleagues describe findings from a prospective analysis of serum lipids and breast cancer risk (1). They observed high-density lipoprotein (HDL) cholesterol to be positively associated and low-density lipoprotein (LDL) cholesterol (non-HDL cholesterol) to be inversely associated with breast cancer risk. They conclude both the discussion and the abstract with a caution that interventions to raise HDL or lower LDL to prevent cardiovascular disease might increase risk for breast cancer.
We believe there is no basis for concern about trade-offs between cardiovascular disease prevention and breast cancer risk and that any such public perceptions could have an adverse impact on public health. In this editorial, we will examine the evidence presented by Martin and colleagues (1) and will argue that because such a trade-off is unlikely to exist, it could be dangerous to whisper such warnings in the theater of public discourse.
The strength of the analysis by Martin and colleagues (1) comes from their multiple measures of serum lipids, which allowed them to both minimize intra-individual variation and also account for confounding effects of time-varying factors related to both endogenous and exogenous female steroid hormones. We think the evidence strongly supports a conclusion that the association between serum lipids and breast cancer risk is because of confounding by circulating steroid hormones or their carrier proteins because of other factors tied to mammographic density and/or because of drinking alcohol. In our view, [… ]
Journal of the National Cancer Institute , éditorial, 2015