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Reduce Breast Cancer bisphosphonates when used to treat osteoporosis?

April 28, 2010

Reduce Breast Cancer bisphosphonates when used to treat Osteoporosis ?

Urdinola Jaime MD

Medical Association Andes CS AK 9116 20 326 Bogotá DC Colombia - Phone 571 / 215 23 00
e-mail: jaimeurdinolamd@gmail.com
blogger: http://www.urdinola.blogspot.com www.urdinolamenopausia2.blogspot.com
Symposium / Luncheon on Women's Health and Menopause Medical Association
Andes - Living Boards - First Floor
Wednesday April 28, 2010

A third study and the first to be published a have reported a reduction in the risk for breast cancer in postmenopausal women take bisphosphonates as a treatment for osteoporosis.

These findings are published in the March 2, 2010 the British Journal of Cancer, reporting a case-control analysis of about 6 000 women in the U.S. Wisconsin stadium aged <>

Polly Newcomb, the study's lead author and Director of the Cancer Prevention Program of the Center for Cancer Research Fred Hutchinson in Seattle, Washington, USA, conceptualized in a press release, this large study provides new evidence that the use of bisphosphonates is associated potentially with a reduced risk for breast cancer.

This reduction in risk for breast cancer is similar to that reported two studies that were submitted in December 2009 in Cancer Symposium Within San Antonio, Texas, USA One of the analysis dealt with 150 000 women who participated in several studies of the WHI (Women's Health Initiative), which found that the use of bisphosphonates (mainly oral alendronate) reduces the risk for breast cancer at 32 %. The other study looked at 4 575 women in a study in northern Israel for 5 years, finding a reduction of 34%.

The fact that they are similar findings in different populations of 2 continents is encouraging, although these findings should be confirmed in controlled trials.
During the symposium in San Antonio discussed the consideration to be done on possible factors called "confounders." Such as women who take bisphosphonates for osteoporosis have low bone mineral density, which is an indicator of reduced estrogen levels, which could influence the risk for breast cancer.

already published in the study, the authors emphasize that they considered important confounding factors such as body mass index and use of postmenopausal hormone therapy. In addition, analyzed the reasons were prescribed bisphosphonates, such as a fracture, the decrease in height and medical diagnosis of osteoporosis. There was some suggestion that the use of bisphosphonates was associated with a reduced breast cancer risk only among women who had reported symptoms related to bone loss, but this was not statistically significant.

these researchers conclude that these findings may reflect real benefits because of anti-tumor mechanisms of bisphosphonates.

Keep in mind, however, that the reduction in breast cancer risk was seen only in women who were not obese, not appreciating in obese women. This suggests that the inhibitory action of these drugs is related to a threshold effect or other hormonal factors growth, which is known to be important factors for exposure in breast cancer.
Obese women may have higher estrogen levels, so that the underlying hormones may influence the ability of bisphosphonates to reduce the risk for breast cancer.

I still do not know the exact mechanism by which bisphosphonates can prevent breast cancer, although these drugs have multiple actions that may be relevant, it has been shown to cause tumor apoptosis, inhibit angiogenesis and prevent tumor cell adhesion, thus affecting cell function and participate in the growth and cell death, specifically in the death of tumor or even premalignant disease.

In women with advanced breast cancer and bone metastases evident, the use of oral or intravenous bisphosphonates in addition to hormone therapy or chemotherapy, when compared with placebo or non-use of bisphosphonates reduces the risk of developing skeletal events and the rate of skeletal events, as well as increases the time to submit a skeletal event 2.
A recent large study has reported beneficial antitumor effects of nitrogenous bisphosphonates in women with breast cancer 3 . This effect was not observed with non-nitrogenous bisphosphonates such as clodronate, and both appear to be toxic for macrophages to the osteoclast.

The idea that bisphosphonates reduce breast cancer is very attractive, considering that only in the U.S. produced about 30 million prescriptions for these agents annually.

As positive conclusion to remember is that these results are suggestive of an additional benefit of the common use of bisphosphonates, in this case, the reduction in risk for breast cancer.


References 1 - Newcomb PA, Trentham-Dietz A, Hampton JM. Bisphosphonates Treatment for osteoporosis Are Associated with Reduced Breast Cancer Risk. Br J Cancer. , 2010; 102:799-802.
2 - Pavlakis N, Stockler M. Bisphosphonates for breast cancer. Cochrane Database Syst Rev. 2002; (1): CD003474.
3 - Gnant M, Mlineritsch B, Schippinger W, et al: Endocrine therapy plus zoledronic acid in premenopausal breast cancer. N Engl J Med 2009, 360:679-691.



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