Objective To examine whether anti-inflammatory drug treatment protects against the commoner cancers in the United Kingdom. Design Case-control study using the general practice research database. Setting Practices throughout United Kingdom providing data to the database. Subjects Patients who had a first diagnosis of five gastrointestinal (oesophagus, stomach, colon, rectum, and pancreas) cancers and four non-gastrointestinal (bladder, breast, lung, and prostate) cancers in 1993-5 for whom prescription data were available for the at least the previous 36 months. Each case was matched for age, sex, and general practice with three controls. Main outcome measure Risk of cancer. Results In 12 174 cancer cases and 34 934 controls overall risk of the nine cancers was not significantly reduced among those who had received at least seven prescriptions in the 13-36 months before cancer diagnosis (odds ratio 0.98, 95% confidence interval 0.89 to 1.07). Findings were nevertheless compatible with protective effects from anti-inflammatory drugs against cancers of the oesophagus (0.64, 0.41 to 0.98), stomach (0.51, 0.33 to 0.79), colon (0.76, 0.58 to 1.00), and rectum (0.75, 0.49 to 1.14) with dose related trends. The risk of pancreatic cancer (1.49, 1.02 to 2.18) and prostatic cancer (1.33, 1.07 to1.64) was increased among patients who had received at least seven prescriptions, but the trend was dose related for only pancreatic cancer. Conclusions Anti-inflammatory drugs may protect against oesophageal and gastric cancer as well as colon and rectal cancer. The increased risks of pancreatic and prostatic cancer could be due to chance or to undetected biases and warrant further investigation.

Adenocarcinoma of the oesophagus has been increasing in incidence in most developed countries in the last two decades (Powell and McConkey, 1990;Blot et al, 1991). The incidence of this condition in British women is among the highest in the world, with half of all cases in Europe occurring in the UK (Black et al, 1997). Previous studies, which had predominantly included men, had identified obesity, diet low in fruit and vegetables, and smoking as the main risk factors (Brown et al, 1995;Vaughan et al, 1995;Gammon et al, 1997;Chow et al, 1998;Lagergren et al, 1999). Little is known about the causes of this cancer in women. Here we report a multi-centre, population-based case-control study among British women together with an estimate of the overall population attributable risk of important risk factors in a multivariate fashion. This population-based case-control study was conducted in the former Regional Health Authorities (RHA) of East Anglia and Oxford, part of Trent RHA and Eastern Scotland covering the Health Boards of Highland, Grampian, Tayside, Fife, Lothian and Forth Valley. Ethical approval was given by all the local research ethics committees.Cases comprised all women aged under 75 years of age (80 years in Trent) resident in the study areas at the time of their diagnosis with oesophageal cancer. Results on adenocarcinoma only are reported here. Cases were identified through pathology departments, treating clinicians and cancer registries and all tumours were histologically confirmed. Care was taken to exclude tumours established as arising in the cardia of the stomach but a small number of cases of those arising at the gastro-oesophageal junction may be included.Cases were accrued over a 2-year period in each study region between 1993 and 1996. A single female control was matched to each case by age (within 5 years) and general practice. Potential controls were randomly selected using the Family Health Service Authority (FHSA) or Health Board primary care registers. Eligible controls who declined to take part were replaced.Women were approached with consultant or General Practitioner (GP) permission and asked for a personal interview. Trained interviewers used a standard form to conduct interviews either in hospital or at home. Information was collected on sociodemographic characteristics, smoking, alcohol, tea and coffee consumption, diet, previous medical and obstetric histories, and a number of other factors, including weight, height and use of vitamin supplements. Smoking was measured in pack years and total years of smoking whilst units of alcohol were categorized by average weekly and total lifetime consumption. A dietary questionnaire was used to obtain information for recent diet (3 years prior to interview) and at age 30 years. Consumption of fresh fruit, salad and vegetables was assessed by questions on food frequency. Categories for analysis were based on quartiles of the frequency of consumption per week among all controls (including those for cases of other histological diagnoses)...

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