## ACE Inhibitors May Fuel Breast Cancer Recurrence

(RxWiki News) If you're a breast cancer survivor and are taking ACE inhibitors for your heart, you may want to talk to your doctor. New findings suggest that ACE inhibitors increase the risk of breast cancer returning.

This new data is coming from researchers at the University of California Los Angeles (UCLA). Dr. Patricia Ganz, director of cancer prevention and control research at UCLA's Jonsson Cancer Center and first author of the study, emphasizes that these are early - "hypothesis generating only" results that need further study.

Dr. Ganz suggests that the findings on ACE inhibitors are reason for concern. These drugs are used to control high blood pressure and heart failure.

Breast cancer survivors who are taking ACE inhibitors may be at increased risk of the cancer returning.

The study also found that beta blockers, also used to treat cardiovascular disease, seem to have a protective effect - actually lowering the risk of recurrence of breast cancer. If ACE inhibitors and beta-blockers are taken together, there is no change in recurrence rates.

"The message from this is we have to be aware of other chronic health problems and medications that patients take after their diagnosis of breast cancer," said Dr. Ganz, an international expert in the fields of quality of life after cancer and cancer survivorship.

"We are learning that some medications, while they may be very helpful for treating cardiovascular disease and hypertension may have an adverse effect on breast cancer survivors," she said.

#### In Depth

  * The study called Life After Cancer Epidemiology (LACE) study includes 1,779 patients diagnosed with early stage breast cancer.
  * Working with investigators at Kaiser Permanente Northern California, Ganz examined the influence of beta blockers and ACE inhibitors on the risk for breast cancer recurrence in a large cohort of early stage breast cancer patients followed for an average of eight years, and for whom pharmacy data on the use of various medications was available. Information about cancer stage, treatments and other chronic conditions also was available.
  * In the study, just published online in the journal _Breast Cancer Research and Treatment_ , Dr. Ganz speculated that ACE inhibitors and beta blockers worked differently in terms of their impact on inflammation. It's long been thought that inflammation fuels cancer growth in humans.
  * A September 2010 Jonsson Cancer Center study showed that chronic stress acts as a sort of fertilizer that feeds breast cancer progression through inflammatory signaling, significantly accelerating the spread of disease in mouse models.
  * The researchers discovered that stress biologically reprogrammed the immune cells trying to fight the cancer, changing them from protectors to spreaders of the disease. The study found a 30-fold increase in cancer spread throughout the bodies of stressed mice compared to those that were not stressed.
  * Researchers were able to block the effects of stress using beta blockers which halted the nervous system's reprogramming of the metastasis-promoting immune cells, called macrophages.



Dr. Ganz said that understanding the biology of stress and inflammation at the cellular level is critical, as healthy lifestyle behaviors such as exercise and stress reduction techniques also may influence the same biological pathways in the tumor microenvironment. Those strategies might also be employed to help prevent recurrence.