A population-based cohort study of the risk of colorectal and other cancers among users of low-dose aspirin

Friis, Søren; Sørensen, Henrik Toft; Jk, McLaughlin; Johnsen, Søren Paaske; Blot, William J.; Olsen, Jørgen H.

doi:10.1038/sj.bjc.6600760

Cited by 147 publications

(196 citation statements)

References 20 publications

(19 reference statements)

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“…An early stage effect appears likely, especially since aspirin has been associated with a clearly reduced risk of large-bowel adenomas that are considered a precursor of most colorectal cancers (Greenberg et al, 1993;Sandler et al, 1998). However, probably there is a threshold for the needed dose, since several studies have shown that low-dose aspirin does not have a major cancer protective effect (Friis et al, 2003). Our data also add to the literature suggesting that NSAIDs may exert an antineoplastic effect in the stomach.…”

Section: Discussionmentioning

confidence: 57%

“…The details of the study design have been described earlier (Friis et al, 2003). The county is served by pharmacies equipped with a computerised accounting system from which data are sent to the Danish National Health Service, which refunds patients part of the costs associated with the purchase of drugs, including NSAIDs, prescribed by doctors, and the prescription data are transferred to the Pharmaco-Epidemiological Prescription Database (Gaist et al, 1997;Sørensen et al, 2000), including the customer's unique civil registry number, the type of drug prescribed (Gaist et al, 1997;Sørensen et al, 2000), and the date of prescription.…”

Section: Methodsmentioning

confidence: 99%

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Risk of cancer in a large cohort of nonaspirin NSAID users: a population-based study

et al. 2003

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There is increasing evidence of an inverse association between use of nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of colorectal cancer. However, data regarding other cancer sites are limited. Using data from the population-based North Jutland Prescription Database and the Danish Cancer Registry, we compared cancer incidence among 172 057 individuals prescribed nonaspirin NSAIDs with expected incidence (based on county-specific cancer rates) during a 9-year study period. A total of 6081 incident cancer cases were diagnosed among NSAID users vs 5722 expected (standardised incidence ratio (SIR) 1.1, 95% confidence interval (CI)1.0 -1.1). The SIRs for colon and rectal cancer among persons who obtained 10 or more prescriptions were 0.7 (95% CI 0.6 -0.9) and 0.6 (95% CI 0.4 -0.9), respectively. Similarly, reduced risk estimates were found for stomach (SIR 0.7, 95% CI 0.4 -1.1) and ovarian cancer (SIR 0.7, 95% CI 0.4 -1.0). Standardised incidence ratios for other cancers among those with 10 or more prescriptions tended to be close to 1.0, except for lung, kidney, and prostate cancers with SIRs of 1.3 (95% CI 1.1 -1.6), 1.4 (95% CI 0.9 -2.1), and 1.6 (95% CI 1.3 -2.0), respectively. We found protective associations of NSAIDs against colon, rectal, stomach, and ovarian cancer. Reasons for the increased risk for some cancer sites are not clear.

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Section: Discussionmentioning

confidence: 57%

Section: Methodsmentioning

confidence: 99%

Risk of cancer in a large cohort of nonaspirin NSAID users: a population-based study

et al. 2003

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“…We excluded retrospective analyses (Rosenberg 1995;Harris et al, 2002;Moysich et al, 2002;Muscat et al, 2003) because of potential biases in aspirin recall and selection of controls and the observed heterogeneity of results from case-control and cohort studies in previous reviews. We also excluded prospective studies that did not account for smoking (Paganini-Hill et al, 1989;Friis et al, 2003;Sorensen et al, 2003) or had no quantitative measure of aspirin use (Shreinemachers and Everson, 1994;Ratnasinghe et al, 2004) because these factors likely influence the association between aspirin and lung cancer. After exclusions, we identified nine studies that met our criteria for inclusion in the review (see Table 4).…”

Section: Literature Reviewmentioning

confidence: 99%

Aspirin and lung cancer risk in a cohort study of women: dosage, duration and latency

et al. 2007

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Aspirin may reduce the risk of cancer at some sites but its effect at the lung is unclear. We prospectively examined associations between aspirin use and risk of lung cancer in 109 348 women in the Nurses' Health study from 1980 to 2004. During this time, 1360 lung cancers were documented in participants 36 -82 years of age. Aspirin use and smoking were assessed every 2 years. Risk of lung cancer was a non-significant 16% lower for regular aspirin users of one or two tablets per week and a significant 55% higher for users of 15 or more tablets per week compared with women who never regularly used aspirin. Results were similar when limited to never smokers. For both the low and high quantity aspirin users, risk of lung cancer did not decline or increase with longer durations of use, and associations attenuated as the latency period between aspirin assessment and lung cancer diagnosis was lengthened. Our findings, together with those from previous clinical trials and prospective studies, do not provide consistent evidence that aspirin influences the development of lung cancer and further investigation is required with adjustment for smoking. British Journal of Cancer (2007) (Benamouzig et al, 2005), most likely through the inhibition of cyclooxygenase enzymes, restoration of normal apoptosis, and reduction of angiogenesis (Zha et al, 2004). However, the influence of aspirin at other tumour sites is less clear. For lung cancer, several meta-analyses with different coverage of published results have offered varying results and interpretations. Of the two that focused solely on lung cancer, aspirin users were found to have a significant 27% lower risk in one (Khuder et al, 2005) and a nonsignificant 9% lower risk in the other (Hernandez-Diaz and Rodriguez, 2007). In two other meta-analyses in which lung cancer was embedded in a wider review of many cancers, the first reported a 16% lower risk for aspirin users that was compatible with no effect or a slightly reduced risk (Gonzalez-Perez et al, 2003), and the other, limited to cohort studies, reported no association (Bosetti et al, 2006). In general, these meta-analyses concluded that a chemopreventive value of aspirin for lung cancer should be interpreted with caution owing to the limitations of the available studies and the heterogeneity of study designs and results. The authors called for larger studies with better exposure characterisation of dose -response measures and detailed adjustment for smoking. In an attempt to resolve these uncertainties, we examined relations between regular aspirin use and risk of invasive lung cancer among women in the Nurses' Health Study (NHS) cohort, taking into consideration quantity, frequency, and duration of use and latency between exposure and diagnosis, while controlling for detailed smoking characteristics. We placed our results within a wider context by conducting a literature review focused on clinical trials and prospective studies that, like our study, had a quantitative measure of aspirin use and controlled for smoking i...

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“…Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) used in relation to lung cancer have been investigated in at least 20 studies, including four hospital-based case -control studies (Rosenberg, 1995;Harris et al, 2002;Moysich et al, 2002;Muscat et al, 2003), fourteen cohort studies (Paganini-Hill et al, 1989;Thun et al, 1993;Schreinemachers and Everson, 1994;Langman et al, 2000;Akhmedkhanov et al, 2002;Friis et al, 2003;Holick et al, 2003;Sørensen et al, 2003;Ratnasinghe et al, 2004;Skriver et al, 2005;Hayes et al, 2006;Hernández-Diaz and Rodriguez, 2007;Jacobs et al, 2007;Wall et al, 2007) and three randomised trials (Peto et al, 1988;Lee et al, 1995;Cook et al, 2007). Significantly decreased risks were observed in three of the four hospital-based case -control studies (Rosenberg, 1995;Harris et al, 2002;Moysich et al, 2002), although all were based on selfreported drug use after diagnosis of cancer, raising the possibility of recall bias.…”

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confidence: 99%

Use of NSAIDs, smoking and lung cancer risk

et al. 2007

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We investigated the risk of lung cancer in relation to non-steroidal anti-inflammatory drugs (NSAIDs) among 573 cases and 857 sex-and age-matched controls for whom we had information on use of NSAIDs, from a prescription database covering all pharmacies in Denmark since 1995, and self-reported NSAID use, smoking habits and other potential confounders. Associations were expressed as odds ratios, assessed by logistic regression in unmatched analyses. After controlling for smoking habits, length of education and concomitant use of acetaminophen, we found a slightly decreased relative risk of 0.86 (95% confidence intervals, 0.65 -1.14) for lung cancer associated with any use of NSAIDs. The risk decreased significantly (P ¼ 0.02) with increasing numbers of dispensed prescriptions per year during the 1 -3 years before the index date with a relative risk of 0.49 (0.28 -0.84) among those with four or more prescriptions per year during this period. Our findings suggest that regular use of NSAIDs is associated with a slightly or moderately reduced risk for lung cancer.

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A population-based cohort study of the risk of colorectal and other cancers among users of low-dose aspirin

Cited by 147 publications

References 20 publications

Risk of cancer in a large cohort of nonaspirin NSAID users: a population-based study

Risk of cancer in a large cohort of nonaspirin NSAID users: a population-based study

Aspirin and lung cancer risk in a cohort study of women: dosage, duration and latency

Use of NSAIDs, smoking and lung cancer risk

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