Aspirin and non-steroidal anti-inflammatory drug use and the risk of upper aerodigestive tract cancer

Abstract

Background:Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are widely used as analgesics and preventative agents for vascular events. It is unclear whether their long-term use affects cancer risk. Data on the chemopreventative role of these drugs on the risk of the upper aerodigestive tract cancer (UADT) are insufficient and mostly refer to oesophageal cancer. The aim of this study was to investigate the effect of aspirin and other NSAIDs on the risk of UADT cancers.Methods:A nested case–control study using the Primary Care Clinical Informatics Unit (PCCIU) database. Conditional logistics regression was used for data analysis.Results:There were 2392 cases of UADT cancer diagnosed between 1996 and 2010 and 7165 age-, gender- and medical practice-matched controls from 131 general medical practices. Mean age of cases was 66 years (s.d. 12) and most were male (63%). Aspirin was prescribed in a quarter of cases and controls, COX-2 inhibitors in 4% of cases and 5% of controls and other NSAIDs in 33% of cases and 36% of controls. Aspirin prescription was associated with a nonsignificant risk reduction of cancer of UADT (adjusted OR=0.9, 95% CI=0.8, 1.0), head and neck (HN; adjusted OR=0.9, 95% CI=0.7, 1.1) or the oesophagus (adjusted OR=0.8, 95% CI=0.7, 1.0). Similar results were found for COX-2 inhibitors prescription. Prescription of other NSAIDs was associated with significantly reduced risk of cancer of UADT (adjusted OR=0.8, 95% CI=0.7, 0.9), HN (adjusted OR=0.8, 95% CI=0.7, 0.9) and the oesophagus (adjusted OR=0.8, 95% CI=0.7, 0.9). An increased volume of aspirin prescriptions was associated with a significant risk reduction (test for trend P<0.001).Conclusions:The decreased risk of cancer of the UADT associated with the use of non-COX-2 inhibitors, NSAIDs and long-term aspirin therapy warrants further exploration of the benefits vs risks of the use of these agents.

Do patients have worse outcomes in heart failure than in cancer? A primary care‐based cohort study with 10‐year follow‐up in Scotland

“…10,11 In brief, PCCIU was founded in 1999 to feedback and are representative of the Scottish population with a similar spread of age, gender, material deprivation and rurality. 12 We carried out a retrospective analysis of PCCIU cohort; our population was all adults aged 16 years or older with an incident diagnosis of either heart failure or a cancer between 1 April 2002 and 31 st March 2011 (the last update of the PCCIU dataset).…”

Regular aspirin use and nasopharyngeal cancer risk: A case-control study in Italy

“…Likewise, regular aspirin use (defined as at least once a week for 1 year) was associated to a borderline 13% risk reduction of upper aero-digestive tract cancer in the AlcoholRelated CAncer and GEnetic Susceptibility (ARCAGE) study [10]. A similar risk reduction was reported for NSAIDs use in upper aerodigestive tract cancer in a recent British case-control study [7]. Finally, aspirin use was inversely -though not significantly -associated with the risk of cancer of the upper aerodigestive tract in Italy (OR = 0.86) [5].…”

“…Studies on head and neck cancers and aspirin use are still scanty and with inconsistent results [5][6][7], and only few of them included NPC [2,6]. Therefore, to further evaluate the possible role of aspirin use on NPC risk in a low-incidence country, we analyzed data from a hospital-based case-control study conducted in Italy.…”

Reduced Risk of Barrett’s Esophagus in Statin Users: Case–Control Study and Meta-Analysis

“…Experimentally statins inhibit proliferation and induce apoptosis in Barrett's cell lines and these effects are enhanced in an additive manner in combination with inhibition of the cyclo-oxygenase-2 pathway (10,11). Over-expression of COX-2 in Barrett's mucosa has been reported, and experimentally (34), and in clinical studies beneficial effects of COX-inhibitors on progression to cancer have been reported (13,16,(35)(36)(37). Thus it is possible that statin and aspirin impair survival of the Barrett's clone at a very early stage and so impair establishment of a mature Barrett's segment.…”