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VA RESEARCH: HIGH-DOSE INHALERS FOR COPD COULD
CUT RISK OF LUNG CANCER -- Researchers found
that
regular use of high-dose inhaled
corticosteroids
lowered the risk of developing lung cancer.
Story here...
http://www.eurekalert.org/
pub_releases/2007-04/ats-hdi032707.php
Story below:
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High-dose inhaled corticosteroid use for COPD
could cut risk of lung cancer
Among a group of mostly older male veterans suffering from chronic
obstructive pulmonary disease (COPD), an illness that offers a greater
susceptibility to lung cancer, researchers found that regular use of
high dose inhaled corticosteroids (ICS) lowered the risk of developing
lung cancer.
The results for this study appear in the first issue for April 2007 of
the American Journal of Respiratory and Critical Care Medicine,
published by the American Thoracic Society.
David H. Au, M.D., M.S., of the Veterans Administration Puget Sound
Health Care System in Seattle, along with five associates found that
among 10,474 patients with COPD, 517 were considered regular users of
ICS.
Among users of more than 1,200 micrograms of ICS per day, the relative
risk for lung cancer was lowered to 0.39. For users of less than 1,200
micrograms per day, the relative risk was 1.13. (A relative risk of 1
means there is no difference in risk between two groups.)
Over the next four years, the researchers found that among a total of
9,957 nonusers of ICS, 402 developed lung cancer. For 298 users of ICS
at a level below 1,200 micrograms per day, 16 developed lung cancer.
Among 219 patients who used over 1,200 micrograms per day, five
developed lung cancer.
"Lung cancer is the most common cause of cancer-related death in the
United States and accounts for more deaths each year than breast,
prostate and colon-rectal cancer combined," said Dr. Au. "Studies such
as the Lung Health Study have demonstrated that the most common cause of
death among subjects with COPD is lung cancer."
In 2004, more than 11 million U.S. adults were estimated to suffer from
COPD, which results from chronic bronchitis and emphysema, two
inflammatory lung diseases that frequently co-exist and interfere with
normal breathing. Smoking is the primary cause of COPD.
"Tobacco smoke is a well-recognized stimulant of systemic and local
inflammation and the role of inflammation in the causal pathway for both
lung cancer and COPD has been suggested," said Dr. Au.
The researchers noted that ICS have been shown in prospective studies to
suppress systemic markers of inflammation such as C-reactive protein and
to reduce airway inflammation.
They hypothesized that higher doses of ICS among the male veterans
reduced such factors as local airway inflammation, cell turnover, and
the propagation of genetic errors. Consequently, these effects could
lead to a subsequent reduction in lung cancer risk.
In an editorial on the research in the same issue of the journal, York
E. Miller, M.D., of the Denver Veterans Affairs Medical Center, and
Robert L. Keith, M.D., of the University of Colorado Cancer Center,
Denver, wrote:
"Although the data at present are certainly not definitive, inhaled
corticosteroids deserve further consideration for lung cancer
chemoprevention. Adequately powered, prospective, controlled trials with
prolonged follow-up to capture effects on a carcinogenic process that
progresses over years will ultimately be needed to determine efficacy.
If these could be designed to capture outcomes of interest relevant to
both lung cancer and COPD, joint funding by the National Cancer
Institute and the National Heart Lung Blood Institute would then be
desirable."
"The risk reduction suggested by the studies discussed would be a
clinically significant achievement, particularly in light of the
continued lung cancer epidemic," the editorialists continued. "Many
additional agents are undergoing evaluation for lung cancer
chemoprevention, including micronutrients, tyrosine kinase inhibitors,
and blockers or agonists of signaling pathways as reviewed. It is hoped,
within the next decade, that chemoprevention of lung cancer in high-risk
individuals (beyond smoking cessation) will be standard in pulmonary and
primary care settings as is influenza vaccination or cardiac risk factor
modification. The potential for benefit is just as great."
###
Contact for study: David H. Au, M.D., M.S., Assistant Professor of
Medicine, Health Services Research and Development (MS152), VA Puget
Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle,
Washington 98101
Phone: (206) 764-2430
E-mail: dau@u.washington.edu
Contact for editorial: York E. Miller, M.D., Professor of Medicine,
Denver Veterans Affairs Medical Center and Univ. of Colorado at Denver
Health Sciences Center, 1055 Clermont Street, Denver, CO 80220
Phone: (303) 393-2869
E-mail: york.miller@uchsc.edu
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Larry Scott --
