This week two patients called me concerned about their high cholesterol possibly causing breast cancer. I’d seen a related news piece come through Medscape with the headline “High Cholesterol May Boost Breast Cancer Risk” and a quick read assured me that this was just another example of the usual drug-company funded anti-fat propaganda that promotes correlation as causation, so I told the callers not to worry and went on with my scheduled appointments.
But a few days later a third patient brought me an article based on the same Medscape article that implied, thanks to the research cited in the article, we now have reason to believe cholesterol pills might help reduce breast cancer risk. That was enough to get me mad. Cholesterol pills for breast cancer prevention would be a boon for drug companies, so obviously I was suspicious. And it would no doubt provoke more phone calls, so I went back to the Medscape article to dig deeper.
Before I go into what I found about high cholesterol and breast cancer, let me give you some backstory on why I don’t trust drug company funded research.
Back in the 1990s, a controversial study on a statin drug called CARE was allegedly stopped early. Of interest, the cancer rates were just about to become significantly higher in the drug arm than the placebo arm of the trial. Once a phenomenon becomes statistically significant it stands a chance of making the news. Of particular interest was the fact that only one woman in the placebo arm developed breast cancer versus 12 women in the group on the statin. The researchers claimed they stopped the study prematurely for other reasons but I don’t quite believe that because, ever since that study, subsequent trials on statin drugs exclude patients with a history of cancer from participation. Why would they do that if the the drug companies really believed statins were safe for cancer patients?
Secondly, and more to the point I want to make here, when I traced the Medscape article back to the abstract summarizing research done by Rahul Potluri, MD, from the Aston University School of Medical Sciences in Birmingham, United Kingdom, I was surprised to find that their lab did not in fact use cholesterol for the research cited in the article. The compound used was a metabolite of cholesterol called 27-OH-Cholesterol. The two molecules have entirely different roles in the body, so right off the bat the headline is a complete misrepresentation of the truth, as was Dr Potluri’s statement that his work “suggests an association between high cholesterol and breast cancer.”
Furthermore, having high cholesterol does not mean you necessarily have high 27-OH-Cholesterol because different people metabolize cholesterol differently, so that a person with low cholesterol may have high 27-OH-Cholesterol and vice versa.
Additionally, the strength of the effect needs to be considered, and that information was not available in the abstract, which is all I have access to. However, usually if there is a strong correlation, information like that will be mentioned in an abstract. So I think we’re probably talking about a weak effect but of course that’s an assumption on my part.
But the article does contain important insights into breast cancer.
I’ve been reading for years of a link between breast cancer and alcohol and always wondered what aspect of metabolism links the two. Perhaps I’m guilting of not really wanting to believe there was a connection because I now live in Napa.
Well, it turns out that the role 27-OH-Cholesterol plays in the body, the reason the body makes any at all, is to direct some cholesterol into bile acids. Bile acids aid digestion as well as eliminate many metabolic byproducts from the body, and are called “detox pathways” for this reason. So it stands to reason that if regular alcohol consumption is impairing your liver’s ability to properly direct traffic, then your 27-OH-Cholesterol may not end up in the gallbladder where it belongs. If, as a result, the compound builds up in the bloodstream to higher than normal levels it could be contributing to abnormal growth and regulation of certain cells, and ultimately contribute to cancer formation.
I can no longer deny the possibility that drinking alcohol does carry real breast cancer risk. I’m not sure how well that news will go over here in the wine capital of the USA, but perhaps, for those with ultimate confidence in their liver detox pathways, it will go over better with a little red.