Abstract
Purpose
Use of non-steroidal anti-inflammatory drugs (NSAIDs) may reduce the incidence of several cancers. A recent meta-analysis of randomized trials of aspirin reported a reduction in cancer mortality; however, few studies have investigated whether aspirin or other NSAIDs reduce overall cancer risk.
Methods
64,847 residents of western Washington State, aged 50–76, completed a baseline questionnaire in 2000–2002 and reported on their use of individual NSAIDs over the past 10 years. Behavior was categorized as non-use, low (<4 days/week or <4 years), and high (≥4 days/week and ≥4 years). Over 7 years of follow-up, 5,946 incident invasive cancer cases were identified. Multivariable proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).
Results
Relative to non-use, high 10-year use of regular-strength NSAIDs was inversely associated with total cancer risk in men (HR 0.88, 95% CI: 0.79–0.97) and not associated with risk in women (HR 1.10, 95% CI: 0.96–1.25; p interaction <0.01). Use of regular-strength NSAIDs was strongly and inversely associated with colorectal cancer risk in men and women, but differentially associated with sex-specific risk of shared cancer sites other than colorectal cancer (men: HR 0.83, 95% CI: 0.71–0.97; women: HR 1.18, 95% CI: 0.97–1.44; p interaction < 0.01).
Conclusions
Long-term use of NSAIDs was associated with a reduced risk of total cancer among men and colorectal cancer among both sexes. Our findings do not support NSAID use for overall cancer prevention among women. Additional high-quality studies with long-term follow-up for cancer among women are needed before a public health recommendation can be made.
Similar content being viewed by others
References
Harris RE, Beebe-Donk J, Doss H, Burr Doss D (2005) Aspirin, ibuprofen, and other non-steroidal anti-inflammatory drugs in cancer prevention: a critical review of non-selective COX-2 blockade (review). Oncol Rep 13:559–583
Rothwell PM, Fowkes FG, Belch JF, Ogawa H, Warlow CP, Meade TW (2011) Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet 377:31–41
Cook NR, Lee IM, Gaziano JM et al (2005) Low-dose aspirin in the primary prevention of cancer: the Women’s Health Study: a randomized controlled trial. JAMA 294:47–55
Jacobs EJ, Thun MJ, Bain EB, Rodriguez C, Henley SJ, Calle EE (2007) A large cohort study of long-term daily use of adult-strength aspirin and cancer incidence. J Natl Cancer Inst 99:608–615
Bardia A, Ebbert JO, Vierkant RA et al (2007) Association of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs with cancer incidence and mortality. J Natl Cancer Inst 99:881–889
Sorensen HT, Friis S, Norgard B et al (2003) Risk of cancer in a large cohort of nonaspirin NSAID users: a population-based study. Br J Cancer 88:1687–1692
Schreinemachers DM, Everson RB (1994) Aspirin use and lung, colon, and breast cancer incidence in a prospective study. Epidemiology 5:138–146
Friis S, Sorensen HT, McLaughlin JK, Johnsen SP, Blot WJ, Olsen JH (2003) A population-based cohort study of the risk of colorectal and other cancers among users of low-dose aspirin. Br J Cancer 88:684–688
White E, Patterson RE, Kristal AR et al (2004) VITamins And Lifestyle cohort study: study design and characteristics of supplement users. Am J Epidemiol 159:83–93
Kim MA, Kim CJ, Seo JB et al (2011) The effect of aspirin on C-reactive protein in hypertensive patients. Clin Exp Hypertens 33:47–52
Menzies D, Nair A, Meldrum KT, Hopkinson P, Lipworth BJ (2008) Effect of aspirin on airway inflammation and pulmonary function in patients with persistent asthma. J Allergy Clin Immunol 121:1184–1189
Littman AJ, Kristal AR, White E (2006) Recreational physical activity and prostate cancer risk (United States). Cancer Causes Control 17:831–841
WCRF/AICR (2007) Food, nutrition and the prevention of cancer: a global perspective. AICR, Washington
Danesh J, Wheeler JG, Hirschfield GM et al (2004) C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. New Engl J Med 350:1387–1397
Pierce BL, Neuhouser ML, Wener MH et al (2009) Correlates of circulating C-reactive protein and serum amyloid A concentrations in breast cancer survivors. Breast Cancer Res Treat 114:155–167
Koenig W, Sund M, Frohlich M, Lowel H, Hutchinson WL, Pepys MB (2003) Refinement of the association of serum C-reactive protein concentration and coronary heart disease risk by correction for within-subject variation over time: the MONICA Augsburg studies, 1984 and 1987. Am J Epidemiol 158:357–364
Bielecka-Dabrowa A, Goch JH, Mikhailidis DP, Rysz J, Maciejewski M, Banach M (2009) The influence of atorvastatin on parameters of inflammation and function of the left ventricle in patients with dilated cardiomyopathy. Med Sci Monit 15:MS12–MS23
Harris NL, Jaffe ES, Diebold J et al (1999) The World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. Report of the Clinical Advisory Committee meeting, Airlie House, Virginia, November, 1997. Ann Oncol 10:1419–1432
Harris NL, Jaffe ES, Diebold J et al (1999) World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol 17:3835–3849
Rothwell PM, Wilson M, Elwin CE et al (2010) Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. Lancet 376:1741–1750
Cole BF, Logan RF, Halabi S et al (2009) Aspirin for the chemoprevention of colorectal adenomas: meta-analysis of the randomized trials. J Natl Cancer Inst 101:256–266
Ready A, Velicer CM, McTiernan A, White E (2008) NSAID use and breast cancer risk in the VITAL cohort. Breast Cancer Res Treat 109:533–543
Brasky TM, Velicer CM, Kristal AR, Peters U, Potter JD, White E (2010) Nonsteroidal anti-inflammatory drugs and prostate cancer risk in the VITamins And Lifestyle (VITAL) cohort. Cancer Epidemiol Biomarkers Prev 19:3185–3188
Slatore CG, Au DH, Littman AJ, Satia JA, White E (2009) Association of nonsteroidal anti-inflammatory drugs with lung cancer: results from a large cohort study. Cancer Epidemiol Biomarkers Prev 18:1203–1207
Asgari MM, Maruti SS, White E (2008) A large cohort study of nonsteroidal anti-inflammatory drug use and melanoma incidence. J Natl Cancer Inst 100:967–971
Walter RB, Milano F, Brasky TM, White E (2011, in press) Long-term use of acetaminophen, aspirin, and other non-steroidal anti-inflammatory drugs and risk of hematologic malignancies: results from the prospective VITamins And Lifestyle (VITAL) study. J Clin Oncol 29(17):2424–2431
Chan AT, Giovannucci EL, Meyerhardt JA, Schernhammer ES, Curhan GC, Fuchs CS (2005) Long-term use of aspirin and nonsteroidal anti-inflammatory drugs and risk of colorectal cancer. JAMA 294:914–923
Takkouche B, Regueira-Mendez C, Etminan M (2008) Breast cancer and use of nonsteroidal anti-inflammatory drugs: a meta-analysis. J Natl Cancer Inst 100:1420–1423
Bonovas S, Filioussi K, Sitaras NM (2005) Do nonsteroidal anti-inflammatory drugs affect the risk of developing ovarian cancer? A meta-analysis. Br J Clin Pharmacol 60:194–203
Khuder SA, Herial NA, Mutgi AB, Federman DJ (2005) Nonsteroidal antiinflammatory drug use and lung cancer: a metaanalysis. Chest 127:748–754
Gonzalez-Perez A, Garcia Rodriguez LA, Lopez-Ridaura R (2003) Effects of non-steroidal anti-inflammatory drugs on cancer sites other than the colon and rectum: a meta-analysis. BMC Cancer 3:28
Cerhan JR, Anderson KE, Janney CA, Vachon CM, Witzig TE, Habermann TM (2003) Association of aspirin and other non-steroidal anti-inflammatory drug use with incidence of non-Hodgkin lymphoma. Int J Cancer 106:784–788
Baker JA, Weiss JR, Czuczman MS, Menezes RJ, Ambrosone CB, Moysich KB (2005) Regular use of aspirin or acetaminophen and risk of non-Hodgkin lymphoma. Cancer Causes Control 16:301–308
Baigent C, Blackwell L, Collins R et al (2009) Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 373:1849–1860
Adelman EE, Lisabeth L, Brown DL (2011) Gender differences in the primary prevention of stroke with aspirin. Women’s Health (London, England) 7:341–352; quiz 52–3
Berger JS, Roncaglioni MC, Avanzini F, Pangrazzi I, Tognoni G, Brown DL (2006) Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials. JAMA 295:306–313
Navarro SL, Saracino MR, Makar KW et al (2011) Determinants of aspirin metabolism in healthy men and women: effects of dietary inducers of UDP-glucuronosyltransferases. J Nutrigenet Nutrigenomics 4:110–118
Waxman DJ, Holloway MG (2009) Sex differences in the expression of hepatic drug metabolizing enzymes. Mol Pharmacol 76:215–228
Acknowledgments
This work is supported by National Institutes of Health and National Cancer Institute grants R25-CA094880 and K05-CA154337.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Brasky, T.M., Potter, J.D., Kristal, A.R. et al. Non-steroidal anti-inflammatory drugs and cancer incidence by sex in the VITamins And Lifestyle (VITAL) cohort. Cancer Causes Control 23, 431–444 (2012). https://doi.org/10.1007/s10552-011-9891-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-011-9891-8