Sir,
We have read with considerable interest the case-control study by Li et al. (2015), in which muscle building supplement (MBS) use was found as an associated factor with testicular germ cell cancer. It is important to remark that the association remained statistically significant even after controlling for important potential confounders. However, we consider that there is one non-assessed variable that might be relevant in the multi-causal model for testicular cancer.
Previous research shows that the frequency of anabolic androgenic steroid (AAS) use within practitioners of recreational physical activity can be as high as 30 (Abrahin et al, 2014) to 50% (Dodge et al, 2011). Therefore, there is high probability of concomitant AAS and MBS use. In addition, AASs have been associated with the development of some types of cancer. Nandrolone and stanozolol, two of the most used AASs, have proven to enhance Leydig cell proliferation, increasing the risk of tumour development in rats (Chimento et al, 2012). There is also suggestive evidence that involves AAS in Leydig cell tumour growth in humans (Belli et al, 2013). In this scenario, AAS could be playing an undetected role in malignancy development instead of or in conjunction with MBS.
Moreover, two recently published articles detected the presence of AAS in products marketed as dietary supplements (Abbate et al, 2014; Odoardi et al, 2015). Thus, the MBS consumed by Li’s study participants could have been contaminated with AAS. This highly probable mix of substances does not allow us to convincingly blame one specific compound.
In summary, Li’s results provide valuable information suggestive of MBS use as a potential risk factor for testicular cancer. However, future research considering the potential AAS effect should be carried out in order to clarify the real influence of this substance.
References
Abbate V, Kicman AT, Evans-Brown M, McVeigh J, Cowan DA, Wilson C, Coles SJ, Walker CJ (2014) Anabolic steroids detected in bodybuilding dietary supplements – a significant risk to public health. Drug Test Anal 7: 609–618.
Abrahin OS, Sousa EC, Santos AM (2014) Prevalence of the use of anabolic-androgenic steroids in Brazil: a systematic review. Subst Use Misuse 49 (9): 1156–1162.
Belli S, Guidi A, Simoni M, Carani C, Granata AR (2013) Leydig cell tumor in an anabolic steroid abuser. J Endocrinol Invest 36 (10): 913.
Chimento A, Sirianni R, Zolea, De Luca A, Lanzino M, Catalano S, Ando S, Pezzi V (2012) Nandrolone and stanozolol induce Leydig cell tumor proliferation through an estrogen-dependent mechanism involving IGF-I system. J Cell Physiol 227: 2079–2088.
Dodge T, Hoagland MF (2011) The use of anabolic androgenic steroids and polypharmacy: a review of the literature. Drug Alcohol Depend 114: 100–109.
Li N, Hauser R, Holford T, Zhu Y, Zhang Y, Bassig BA, Honig S, Chen C, Boyle P, Dai M, Schwartz SM, Morey P, Sayward H, Hu Z, Shen H, Gomery P, Zheng T (2015) Muscle-building supplement use and increased risk of testicular germ cell cancer in men from Connecticut and Massachusetts. Br J Cancer 112: 1247–1250.
Odoardi S, Castrignanò E, Martello S, Chiarotti M, Strano-Rossi S (2015) Determination of anabolic agents in dietary supplements by liquid chromatography-high-resolution mass spectrometry. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 32 (5): 635–647.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
This work is licensed under the Creative Commons Attribution-Non-Commercial-Share Alike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/
About this article
Cite this article
Cazorla-Saravia, P., Pereyra-Elías, R. Is it the creatine or the anabolic androgenic steroids? Need for assessing the steroids role in testicular cancer. Br J Cancer 113, 1638 (2015). https://doi.org/10.1038/bjc.2015.294
Published:
Issue Date:
DOI: https://doi.org/10.1038/bjc.2015.294