Breast Cancer Research and Treatment

, Volume 101, Issue 2, pp 191–197 | Cite as

NSAID use and survival after breast cancer diagnosis in post-menopausal women

  • Cindy K. Blair
  • Carol Sweeney
  • Kristin E. Anderson
  • Aaron R. Folsom


Many epidemiologic studies, although not all, have shown an inverse relation between non-steroidal anti-inflammatory drug (NSAID) use and risk of incident breast cancer, but the possible influence of NSAID use on breast cancer survival has not been evaluated. We examined the association between self-reported NSAID use and survival after invasive breast cancer diagnosis among 591 postmenopausal women in a prospective study. Cox proportional hazards regression was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for breast cancer death as well as all-cause mortality associated with NSAID use. There was an indication of reduced risk of breast cancer mortality and all-cause mortality for women reporting any versus no use of NSAIDs, with multivariate-adjusted HRs of 0.64 (95% CI 0.39–1.05) and 0.57 (95% CI 0.40–0.81), respectively. There was no trend of decreasing risk of death with increasing frequency of NSAID use per week. While the results from this exploratory analysis are preliminary, there is biological plausibility for such an association. Further studies should consider whether NSAIDs, which have biological activity affecting tumor promotion and progression and appear to protect against breast cancer incidence, may be associated with better prognosis after a diagnosis of invasive breast cancer.


Anti-inflammatory agents Aspirin Breast cancer Non-steroidal Survival 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.



The authors thank the staff and participants in the IWHS study for their important contributions. A special thanks to Ching-Ping Hong for her valuable assistance.


  1. 1.
    Sharpe CR, Collet JP, McNutt M, Belzile E, Boivin JF, Hanley JA (2000) Nested case-control study of the effects of non-steroidal anti-inflammatory drugs on breast cancer risk and stage. Br J Cancer 83(1):112–120PubMedCrossRefGoogle Scholar
  2. 2.
    Egan KM, Stampfer MJ, Giovannucci E, Rosner BA, Colditz GA (1996) Prospective study of regular aspirin use and the risk of breast cancer. J Natl Cancer Inst 88(14):988–993PubMedCrossRefGoogle Scholar
  3. 3.
    Paganini-Hill A, Chao A, Ross RK, Henderson BE (1989) Aspirin use and chronic diseases: a cohort study of the elderly. BMJ 299(6710):1247–1250PubMedCrossRefGoogle Scholar
  4. 4.
    Rosenberg L (1995) Nonsteroidal anti-inflammatory drugs and cancer. Prev Med 24(2):107–109PubMedCrossRefGoogle Scholar
  5. 5.
    Langman MJ, Cheng KK, Gilman EA, Lancashire RJ (2000) Effect of anti-inflammatory drugs on overall risk of common cancer: case–control study in general practice research database. BMJ 320(7250):1642–1646PubMedCrossRefGoogle Scholar
  6. 6.
    Harris RE, Kasbari S, Farrar WB (1999) Prospective study of nonsteroidal anti-inflammatory drugs and breast cancer. Oncol Rep 6(1):71–73PubMedGoogle Scholar
  7. 7.
    Coogan PF, Rao SR, Rosenberg L, Palmer JR, Strom BL, Zauber AG, Stolley PD, Shapiro S (1999) The relationship of nonsteroidal anti-inflammatory drug use to the risk of breast cancer. Prev Med 29(2):72–76PubMedCrossRefGoogle Scholar
  8. 8.
    Schreinemachers DM, Everson RB (1994) Aspirin use and lung, colon, and breast cancer incidence in a prospective study. Epidemiology 5(2):138–146PubMedCrossRefGoogle Scholar
  9. 9.
    Harris RE, Namboodiri K, Stellman SD, Wynder EL (1995) Breast cancer and NSAID use: heterogeneity of effect in a case–control study. Prev Med 24(2):119–120PubMedCrossRefGoogle Scholar
  10. 10.
    Harris RE, Namboodiri KK, Farrar WB (1996) Nonsteroidal antiinflammatory drugs and breast cancer. Epidemiology 7(2):203–205PubMedCrossRefGoogle Scholar
  11. 11.
    Johnson TW, Anderson KE, Lazovich D, Folsom AR (2002) Association of aspirin and nonsteroidal anti-inflammatory drug use with breast cancer. Cancer Epidemiol Biomarkers Prev 11(12):1586–1591PubMedGoogle Scholar
  12. 12.
    Brueggemeier RW, Quinn AL, Parrett ML, Joarder FS, Harris RE, Robertson FM (1999) Correlation of aromatase and cyclooxygenase gene expression in human breast cancer specimens. Cancer Lett 140(1–2):27–35PubMedCrossRefGoogle Scholar
  13. 13.
    Soslow RA, Dannenberg AJ, Rush D, Woerner BM, Khan KN, Masferrer J, Koki AT (2000) COX-2 is expressed in human pulmonary, colonic, and mammary tumors. Cancer 89(12):2637–2645PubMedCrossRefGoogle Scholar
  14. 14.
    Bennett A, Charlier EM, McDonald AM, Simpson JS, Stamford IF, Zebro T (1977) Prostaglandins and breast cancer. Lancet 2(8039):624–626PubMedCrossRefGoogle Scholar
  15. 15.
    Karmali RA, Welt S, Thaler HT, Lefevre F (1983) Prostaglandins in breast cancer: relationship to disease stage and hormone status. Br J Cancer 48(5):689–696PubMedGoogle Scholar
  16. 16.
    Rolland PH, Martin PM, Jacquemier J, Rolland AM, Toga M (1980) Prostaglandin in human breast cancer: evidence suggesting that an elevated prostaglandin production is a marker of high metastatic potential for neoplastic cells. J␣Natl Cancer Inst 64(5):1061–1070PubMedGoogle Scholar
  17. 17.
    Spizzo G, Gastl G, Wolf D, Gunsilius E, Steurer M, Fong D, Amberger A, Margreiter R, Obrist P (2003) Correlation of COX-2 and Ep-CAM overexpression in human invasive breast cancer and its impact on survival. Br J Cancer 88(4):574–578PubMedCrossRefGoogle Scholar
  18. 18.
    Ristimaki A, Sivula A, Lundin J, Lundin M, Salminen T, Haglund C, Joensuu H, Isola J (2002) Prognostic significance of elevated cyclooxygenase-2 expression in breast cancer. Cancer Res 62(3):632–635PubMedGoogle Scholar
  19. 19.
    Tsujii M, Kawano S, Tsuji S, Sawaoka H, Hori M, DuBois RN (1998) Cyclooxygenase regulates angiogenesis induced by colon cancer cells. Cell 93(5):705–716PubMedCrossRefGoogle Scholar
  20. 20.
    Rozic JG, Chakraborty C, Lala PK (2001) Cyclooxygenase inhibitors retard murine mammary tumor progression by reducing tumor cell migration, invasiveness and angiogenesis. Int J Cancer 93(4):497–506PubMedCrossRefGoogle Scholar
  21. 21.
    Sheng H, Shao J, Morrow JD, Beauchamp RD, DuBois RN (1998) Modulation of apoptosis and Bcl-2 expression by prostaglandin E2 in human colon cancer cells. Cancer Res 58(2):362–366PubMedGoogle Scholar
  22. 22.
    Thun MJ, Namboodiri MM, Calle EE, Flanders WD, Heath CW Jr (1993) Aspirin use and risk of fatal cancer. Cancer Res 53(6):1322–1327PubMedGoogle Scholar
  23. 23.
    Thun MJ, Namboodiri MM, Heath CW Jr (1991) Aspirin use and reduced risk of fatal colon cancer. N Engl J Med 325(23):1593–1596PubMedCrossRefGoogle Scholar
  24. 24.
    Folsom AR, Kaye SA, Prineas RJ, Potter JD, Gapstur SM, Wallace RB (1990) Increased incidence of carcinoma of the breast associated with abdominal adiposity in postmenopausal women. Am J Epidemiol 131(5):794–803PubMedGoogle Scholar
  25. 25.
    Folsom AR, Kushi LH, Anderson KE, Mink PJ, Olson JE, Hong CP, Sellers TA, Lazovich D, Prineas RJ (2000) Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women’s Health Study. Arch Intern Med 160(14):2117–2128PubMedCrossRefGoogle Scholar
  26. 26.
    Vachon CM, Sellers TA, Kushi LH, Folsom AR (1998) Familial correlation of dietary intakes among postmenopausal women. Genet Epidemiol 15(6):553–563PubMedCrossRefGoogle Scholar
  27. 27.
    Ratnasinghe LD, Graubard BI, Kahle L, Tangrea JA, Taylor PR, Hawk E (2004) Aspirin use and mortality from cancer in a prospective cohort study. Anticancer Res 24(5B):3177–3184PubMedGoogle Scholar
  28. 28.
    Han EK, Arber N, Yamamoto H, Lim JT, Delohery T, Pamukcu R, Piazza GA, Xing WQ, Weinstein IB (1998) Effects of sulindac and its metabolites on growth and apoptosis in human mammary epithelial and breast carcinoma cell lines. Breast Cancer Res Treat 48(3):195–203PubMedCrossRefGoogle Scholar
  29. 29.
    Hsu AL, Ching TT, Wang DS, Song X, Rangnekar VM, Chen CS (2000) The cyclooxygenase-2 inhibitor celecoxib induces apoptosis by blocking Akt activation in human prostate cancer cells independently of Bcl-2. J Biol Chem 275(15):11397–11403PubMedCrossRefGoogle Scholar
  30. 30.
    Lala PK, Al-Mutter N, Orucevic A (1997) Effects of chronic indomethacin therapy on the development and progression of spontaneous mammary tumors in C3H/HEJ mice. Int J␣Cancer 73(3):371–380PubMedCrossRefGoogle Scholar
  31. 31.
    Masferrer JL, Leahy KM, Koki AT, Zweifel BS, Settle SL, Woerner BM, Edwards DA, Flickinger AG, Moore RJ, Seibert K (2000) Antiangiogenic and antitumor activities of cyclooxygenase-2 inhibitors. Cancer Res 60(5):1306–1311PubMedGoogle Scholar
  32. 32.
    Davies G, Martin LA, Sacks N, Dowsett M (2002) Cyclooxygenase-2 (COX-2), aromatase and breast cancer: a possible role for COX-2 inhibitors in breast cancer chemoprevention. Ann Oncol 13(5):669–678PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Cindy K. Blair
    • 1
  • Carol Sweeney
    • 2
  • Kristin E. Anderson
    • 3
  • Aaron R. Folsom
    • 3
  1. 1.University of Minnesota Cancer CenterMinneapolisUSA
  2. 2.Department of Family and Preventive MedicineUniversity of UtahSalt Lake CityUSA
  3. 3.Division of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisUSA

Personalised recommendations