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A review by Konstantinopoulos et al (2007) mentions, among several possible antitumor mechanisms of statins, the importance of post-translational modifications.Statins inhibit production of isoprenoids, which are one of the important products of the mevalonate pathway and substrates for geranylgeranylation, a type of post-translational modification that adds the geranylgeranyl isoprene unit to the target protein, such as RHO proteins, thus inhibiting carcinogenesis (Konstantinopoulos et al, 2007).In the multivariable Cox model, H-statins were associated with significantly improved PFS compared with no statin (hazard ratio=0.49; 95% confidence interval=0.28–0.84; PInflammatory breast cancer (IBC) is rare, comprising only 2–5% of breast cancer incidences, but is the most lethal type of breast cancer, representing 8–10% of breast cancer mortality (Keeneth et al, 2005).Clinically, IBC presents with apparent inflammatory changes of the breast, characterised by diffuse erythema and oedema of the skin with or without an underlying palpable mass.We searched the Inflammatory Breast Cancer Database compiled by the Breast Cancer Management System at MD Anderson Cancer Center, which contains 1177 entries of patients diagnosed with all stages of IBC between 24 February 1970 and 27 January 2011.The following exclusion criteria were applied: IBC diagnosed before 1995, stage IV disease, secondary IBC, suspected non-IBC breast cancer, unknown clinical stage, statin use after the initial evaluation at MD Anderson, unclear statin type, and notation of ‘restricted information’ in MD Anderson’s electronic medical record (EMR) system.The main purpose of this observational study was to determine whether statin use affected the recurrence rate and survival in patients with primary IBC who were treated at The University of Texas MD Anderson Cancer Center from 1995 to 2011.

Overall results of multiple epidemiologic studies on the effects of statin use on breast cancer risks, however, are inconclusive with the majority finding no clear association (Bonovas et al, 2005).The diagnosis is pathologically confirmed by recognising invasive carcinoma in a core biopsy specimen (Dawood et al, 2011).Although patients with primary IBC have no evidence of distant metastases at the time of diagnosis, the disease tends to have rapid progression from onset, higher risk of recurrence, and shortened survival compared with locally advanced non-IBC (Cristofanilli et al, 2007).Although calling this type of breast cancer ‘inflammatory’ implies the existence of an underlying inflammatory mechanism, the term is a clinical description reflecting redness of the skin and does not denote the presence of an obvious pathologic inflammatory infiltrate in these tumours.Statins, 3-hydroxyl-3-methylglutaryl coenzyme A (HMG-Co A) reductase inhibitors, are cholesterol-lowering agents that significantly reduce cardiovascular events and overall mortality; they are also recognised as powerful anti-inflammatory agents Lefer (2002).

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