Medscape Misleading Doctors About Statin Benefits for Breast Cancer

Statin drugs can’t fight cancer. But Medscape wants your doctor to think they can.

Statins lower cholesterol. They are typically prescribed to prevent heart attacks. (And they don’t do that well, as shown here.) But drug companies are also trying to market them for cancer prevention. They just might pull it off, with help from medical news outlets like Medscape. Let me show you how.

Medscape is a popular website for medical doctors to stay up to date. Unfortunately, in the same way that the 60 Minutes story about Ozempic was basically an advertisement, Medscape also takes advantage of its audience to do a little marketing for drug companies. It’s a lot sneakier than 60 Minutes, though, because most doctors are tragically naive. Too few of my colleagues seem to consider the implications of the fact that, just like any other news outlet, Medscape needs to butter its bread with drug company money, too.

If you’re a health professional, you should know that these outlets don’t just take drug company money. They also pull some underhanded tricks. So I want to show you one of the sneaky strategies they use to support the drug industry. I’ve seen this particular strategy more than once–and it’s terrifyingly effective. 

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If you’re not a health professional, I want you to appreciate just how hard it can be for your doctor to learn the truth about drugs. Particularly statins.

How to create fake statin cancer benefits in two easy steps.

Step one. A respectable peer-reviewed journal publishes some research involving statins and women with breast cancer. In this case, the journal in question is called The Journal of Clinical Oncology. The article fails to publish its data in a clear, easy-to-understand format that a non-statistician could understand. (This is not required but should be.) Because the data is effectively unintelligible, they can make exaggerated claims about the results. (I’ll show you the details below.)

Step two, a news outlet like Medscape cites the original research but makes a patently false claim about the study. In this case, the claim is that the study randomized the women with breast cancer to take a statin or not. But once you’ve read their news article, even if you click on the link to read the study, it’s almost impossible to recognize the statin-randomization lie.

Why is it so hard to see the lie? Because of psychology.

It turns out that once an idea is placed in our minds, we’ll be inclined to see new information within the paradigm of that original idea. It’s a mental shortcut, of sorts. So once we get it into our heads that a certain study shows a certain thing, we may read that original idea into the study even when the study itself says no such thing.

Let’s get into this latest misleading statin cancer article.

Here’s what Medscape wants doctors to believe. It’s also the title of the article. (And you can read it here.)

“Statin Use May Extend Life for Breast Cancer Patients” 

Medscape gives us this FALSE summary of the study in question:

“Data from a randomized trial published in the Journal of Clinical Oncology in 2017 showed significantly improved disease-free survival, breast cancer-free interval, and distant recurrence-free interval in early-stage breast cancer patients randomized to cholesterol-lowering medication vs. those who did not receive cholesterol-lowering medication.”

As you can see, the sentence claims that patients were randomized to either take a cholesterol-lowering medication or not. This implies women got statins even if they had low cholesterol. It implies that whether their cholesterol was low or high, the statin helped. Doctors likely come away believing that if a woman has a history of breast cancer, we should consider telling her to take a statin no matter what her cholesterol and heart attack risk may be.

One in seven women will be diagnosed with breast cancer in our lifetimes. So this is a very large new group of potential statin users.

The randomization lie.

The Medscape article suggests that women were randomized to take either a statin or no statin. In reality, they were randomized to different hormonal treatments for their cancer. They were not randomized to take statins. The study wasn’t even centered on cholesterol medications. It was mainly about which of three available hormone treatments prevented breast cancer reoccurrence more effectively. As a secondary subject, it also evaluated women who were treated for high cholesterol with any medication, including statins.

(NOTE: Cholesterol does not really cause heart disease, and “high” cholesterol should be called “normal cholesterol” because having cholesterol in our bloodstream is not a disease.)

To be clear, only women with high cholesterol got medications. The women were not randomized to statin or no statin. They were simply given a prescription to take any old drug for their high cholesterol. And there’s no analysis as to whether or not they filled the prescription or took statins or some other drug.

Still, I almost didn’t notice the randomization switcharoo. The Medscape article had placed the statin-no-statin randomization idea in my mind and that affected how I thought about the article. When I started reading the study I fully believed that, as Medscape claimed, patients were randomized to cholesterol drugs or no cholesterol drugs. Even after reading the article I still didn’t notice the misrepresentation.

Only when I started to write about the study results to try to explain what I thought was really going on with high cholesterol and cancer did I realize Hey wait a second here. A closer read made it clear that the Medscape article says one thing and the actual article says another.

The original article also makes misleading statements about cholesterol-lowering drugs like statins.

This ruse would not work so well if the original article Medscape claims to be summarizing presented their results honestly and in an easy-to-read format. But they don’t.

The original article makes this misleading statement about the effects of taking a statin or other cholesterol-lowering medication (CLM):  “In the BIG 1-98 trial, initiation of CLM while receiving adjuvant endocrine therapy improved clinical outcome for patients with ER-positive breast cancer.”

The deception in that phrase is “improved clinical outcomes.” Since the trial was not randomized, they can’t make a causative connection like that. They needed to have said “was associated with improved clinical outcome….” This slight wording alteration might seem like no big deal. But in the world of peer review science, it is. This should not have passed the peer review process.

Why did it?

Probably because just like Medscape editors know who butters their bread, so do the editors of peer-reviewed medical journals.

Exactly what are those “improved clinical outcomes?”

It’s hard to tell. It was very hard for me to wade through all the jargon. That, too, is likely intentional because it means we are likely to assume we’re just too dumb to understand the numbers presented and just blip over them to get to that misleading summary. There, we read the badly worded claim that “initiation of CLM while receiving adjuvant endocrine therapy improved clinical outcome.”

Whenever the outcomes are presented in a muddy way, chances are it’s intentional. Somebody wants to obscure the truth.

In this case, I think they’re trying to hide the magnitude of this “improved” clinical outcome.  More likely than not, the supposed benefits of cholesterol medications were so small they would not be clinically meaningful. Perhaps they delayed recurrence by a day, for example. If they were meaningful, then the authors would have explicitly stated this important information.

They muddied the results with jargon.

For your amusement, here’s the language from the results section that we’re supposed to be able to interpret.

According to marginal structural Cox models, initiation of CLM during any endocrine therapy appeared to be associated with improved DFS (HR_adj, 0.79; 95% CI, 0.66 to 0.95; P = .01), BCFI (HR_adj, 0.76; 95% CI, 0.60 to 0.97; P = .02), and DRFI (HR_adj, 0.74; 95% CI, 0.56 to 0.97; P = .03; Table 4). 

(DFS, BCFI, and DRFI stand for Disease-Free Survival, Breast Cancer Free Interval, and Distant Recurrence Free Interval. )

The DFS HR of .79 means that adding cholesterol-lowering drugs to endocrine therapy reduced the risk of recurrence by 21% compared to whatever the rate was in the group that didn’t get cholesterol meds. The CI numbers being under 1.00 mean that the effect is likely nonrandom.

The BCFI HR of .76 likewise means that adding cholesterol-lowering drugs to endocrine therapy reduced the risk of recurrence by 24% compared to whatever the rate was in the group that didn’t get cholesterol meds. The CI numbers being under 1.00 mean that the effect is also likely nonrandom.

The DRFI HR of .74 means that adding cholesterol-lowering drugs to endocrine therapy reduced the risk of recurrence by 26% compared to whatever the rate was in the group that didn’t get cholesterol meds. Again, the CI numbers being under 1.00 mean that this effect (of unclear magnitude) is likely nonrandom.

And there’s more…

When you crunch the data a different way, there is NO benefit to taking cholesterol drugs. 

In analyses of the two monotherapy arms, initiation of CLM showed no benefit on clinical outcome in the tamoxifen arm DFS (HR_adj, 0.99; 95% CI, 0.56 to 1.74; P = .97), BCFI (HR_adj, 0.85; 95% CI, 0.42 to 1.74; P = .44), and DRFI (HR_adj, 0.57; 95% CI, 0.24 to 1.35; P = .20), and a nonsignificant trend toward a benefit among patients in the letrozole arm DFS (HR_adj, 0.66; 95% CI, 0.40 to 1.08; P = .10), BCFI (HR_adj, 0.77; 95% CI, 0.40 to 1.48; P = .44), and DRFI (HR_adj, 0.70; 95% CI, 0.31 to 1.59; P = 0.40; Data Supplement).

Kind of a mess, right? Well yeah. And most doctors won’t have the time or inclination to sift through all that mumbo jumbo.

Medscape to the rescue!

That’s how they get away with lying.

But wait, I’m not done trashing this article yet…

As I stated at the beginning of this article, statins don’t prevent cancer. If anything, they are likely to increase cancer risk. So this article also provides a great example of how the lie that cholesterol can be bad for our health helps foment another lie. Namely, that lowering cholesterol might prevent cancer. (Chapter five of Dark Calories is called The Truth about Cholesterol because the truth is cholesterol is a nutrient but most doctors believe it is toxic.)

Women with high cholesterol had less cancer recurrence.

In the study, women with low or normal cholesterol did not get statins. They did not do as well, either. On the other hand, women with high cholesterol did get statins. And they did better. (Although in truth it was probably only a very tiny bit better.) The article’s authors want us to believe that improvement was due to the drugs they took. But there’s a confounding variable they don’t mention. Women who got the drug also had higher cholesterol. Was it the drug that helped them? Or was it the fact that they had high cholesterol?

This is a really important confounding variable, given the concerning evidence suggesting that low cholesterol increases the risk of all sorts of cancers.  Indeed, a statin trial done back in 1996 showed “An alarming increase in breast cancer incidence, some of which were recurrences…in women randomized to pravastatin.” Ever since that study, people with cancer have been excluded from major trials testing statins! (For example, the Jupiter trial) That strongly suggests to me that drug companies believe people who have cancer should stay away from cholesterol-lowering drugs.

Remember, statins disrupt many cell functions, including immune system function. And immune surveillance helps keep cancer cells in check. In other words, it seems that women with higher cholesterol did better in spite of the statin, not because of it.

Here’s what I think really explains any findings of any benefit from cholesterol-lowering drugs on cancer. 

The real story here is that people with higher cholesterol have better outcomes than people with lower cholesterol!

In other words, if women on cholesterol drugs did indeed survive significantly longer (and that’s an open question), it was in spite of the statin, not because of it. 

More coverage that helps mislead doctors.

This article is one of many that promotes the dubious statin-cancer benefit.

The MD Anderson Cancer newsroom reports on this study here https://www.mdanderson.org/newsroom/statins-may-improve-survival-for-triple-negative-breast-cancer-patients.h00-159462423.html

Another news outlet reports another study here, hypothesizing that by lowering cholesterol you also lower cellular estrogen production without producing good evidence to support that idea other than suggesting estrogen is a carcinogen, which is patently absurd. https://www.news-medical.net/news/20231121/Statins-may-reduce-breast-cancer-mortality-rates.aspx

2008 article pushing statins for breast cancer prevention https://www.health.harvard.edu/heart-health/the-status-of-statins

How to arm yourself against this stream of misinformation.

Whether you’re a health professional or not, you have been and will continue to be bombarded by misinformation about drugs, supplements, and quick fixes for cancer–and everything else. It can feel overwhelming, especially since the claims are often contradictory. Who benefits when you’re confused? The sick care industry and the people selling supplements and other quick fixes.

My work has convinced me that cancer, heart disease, and all other metabolic diseases are mainly due to oxidative stress. I’m also convinced that our unhealthy, vegetable oil and processed ingredient diet promote oxidative stress. Drugs can’t help our bodies recover from metabolic diseases. But a healthy diet can. And one key to enjoying a healthy diet is coming to understand that cholesterol is a nutrient, not a toxin.

I cover that subject in many articles and especially in my latest book Dark Calories, in Chapter 5, called The Truth About Cholesterol.

The truth will set you free. But first, it will piss you off.