Some studies which associate increased MCT4 expression in cancer cells with decreased survival using the Warburg Effect as a model attribute decreased survival to an acidic microenvironment [26, 29–31, 33] provided by MCT4-mediated lactate efflux causing matrix metalloproteinase activation [29, 30], cathepsin activation [29, 30], decreased natural killer cell activation [29, 30], decreased effectiveness of chemotherapy [26], and increased integrin interactions [33]. This evidence concerns the gene SLC16A4 and cancer.