African American women in the U.S. have a higher mortality rate from breast cancer than white women. Black-white differences in survival persist even after accounting for disease stage and tumor characteristics suggesting that the higher rates of breast cancer mortality are due to social factors. Several factors may account for racial differences in breast cancer mortality including socioeconomic factors, access to screening mammography and timely treatment, and biological factors. Efforts to prevent deaths from breast cancer and to address breast cancer disparities have focused on early detection through routine mammography and timely referral for treatment. There is a need for culturally appropriate, tailored health messages for African American women to increase their knowledge and awareness of health behaviors for the early detection of breast cancer. Several promising intervention approaches are reviewed in this article including: 1) the use of cell phone text messaging and smart phone apps to increase breast cancer screening; 2) the use of radio stations that target African American audiences ("black radio") for health promotion activities; and 3) church-based behavioral interventions to promote breast cancer screening among African American women.
Background: Metformin has shown promise for cancer prevention. Prior studies suggested that metformin might interact potential prostate cancer (PCa) prevention agents: finasteride and statins. This study assessed if concurrent use of statins or finasteride modified the long-term impact of metformin on PCa risk in men with type 2 diabetes (T2DM).
Materials and methods: The study cohort consisted of 71,999 men with T2DM seen in the Veteran Administration Health Care System, without prior cancer or liver diseases, nor prescription of thiazolidinediones or insulin between FY2003-FY2013. Cox proportional hazard analyses (adjusting for covariates and propensity scores of metformin use) were conducted to compare the hazard ratio (HR) of PCa associated with metformin use between statins or finasteride users and none users.
Results: Mean follow-up was 6.4±2.8 years; 5.2% (N= 3,756) of the cohort subsequently received a PCa diagnosis. Both statins and finasteride significantly modified the impact of metformin on PCa incidence (p-value<0.001): HR's of PCa associated with metformin use were 0.89 (p-value=0.02) among non-statin/non-finasteride users, 0.73 (p-value<0.001) among statin users, and 1.42 (p-value<0.001) among finasteride users.
Conclusion: Metformin was associated with reduced PCa risk in men with T2DM. This impact was enhanced by statins but reversed by finasteride. Metformin, statins, and finasteride are potential PCa prevention agents. The interaction of these drugs on PCa risk needs further confirmation in other cohorts. Our finding of differential impacts of metformin, statins, and finasteride (alone or in combination) on PCa risk is informative for treatment management in men at risk for PCa and T2DM.
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