Association between frequent use of nonsteroidal anti-inflammatory drugs and breast cancer

Rahme, Elham; Ghosn, Joumana; Dasgupta, Kaberi; Rajan, Raghu; Hudson, Marie

doi:10.1186/1471-2407-5-159

Cited by 68 publications

(55 citation statements)

References 33 publications

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“…In a study using a Canadian automated database, there was no association for frequent use of aspirin at a dose of p100 mg day À1 , but an inverse association at a dose of 4100 mg day À1 (Rahme et al, 2005). By contrast, in the UK General Practice Research Database, a significant reduction was seen only for a daily 75 mg dose, but not for daily doses of 150 and 300 mg (Garcia Rodriguez and Gonzalez-Perez, 2004).…”

Section: Discussionmentioning

confidence: 99%

Low-dose aspirin and breast cancer risk: results by tumour characteristics from a randomised trial

Manson

et al. 2008

Br J Cancer

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The Women's Health Study trial previously reported no overall effect of low-dose aspirin (100 mg every other day) on invasive breast cancer over an average of 10 years of treatment. The present subgroup analyses further show no effects by tumour characteristics at diagnosis, suggesting that low-dose aspirin has no preventive effect on breast cancer. Aspirin inhibits cyclooxygenase enzymes (COX-1 and -2) (DuBois, 2004). Cyclooxygenase 2 (COX-2) overexpression induces the occurrence of mammary tumours in transgenic mice (Liu et al, 2001). Prostaglandin E2 that is generated from COX-2 overexpression stimulates the expression of cytochrome P450 aromatase, a key enzyme in local oestrogen production, and induces angiogenesis (DuBois, 2004). Cyclooxygenase 2 overexpression occurs in approximately 40% of invasive breast cancer, and is more common in tumours with large size, lymph node metastasis, a ductal type of histology, high histological grade, or negative hormone receptor status (Ristimaki et al, 2002). Thus, the effect of aspirin may be stronger in these subtypes of tumours.In July 2005, the Women's Health Study (WHS) reported overall results from the only randomised trial of aspirin and cancer risk in women (Cook et al, 2005). After an average of 10 years of treatment and follow-up, low-dose aspirin (100 mg every other day) had no effect on risk of invasive breast cancer overall or by combined hormone receptor status in 39 876 women aged X45 years. In a subgroup analysis, we evaluate whether low-dose aspirin might reduce risk according to tumour characteristics at diagnosis. MATERIALS AND METHODS Study designDuring 1992 -1996, a total of 39 876 women with no history of cancer or cardiovascular disease were enrolled and randomised into a 2 Â 2 factorial design of low-dose aspirin (100 mg every other day, provided by the Bayer HealthCare, Leverkusen, Germany) and vitamin E (600 IU every other day, provided by the Natural Source Vitamin E Association) for the primary prevention of cancer and cardiovascular disease (Clinicaltrials.gov identifier, NCT00000479). The methods of the study design have been described in detail previously (Cook et al, 2005). Written informed consent was obtained from each participant. The trial was approved by the Human Subjects Committee at the Brigham and Women's Hospital and monitored by an external Data and Safety Monitoring Board.Annually, participants were sent monthly calendar packs containing study medications, and questionnaires inquiring about potential adverse effects, adherence to pill taking, and occurrence of disease outcomes. Study medications and disease ascertainment were continued in blinded fashion through the scheduled end of the trial (31 March 2004). Deaths of participants were identified by reports from family members, postal authorities, and a search of the National Death Index. Morbidity and mortality follow-up were 97.2 and 99.4% complete, respectively (Cook et al, 2005).For reported diagnoses of breast cancer, medical records and other relevant information were so...

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Section: Discussionmentioning

confidence: 99%

Low-dose aspirin and breast cancer risk: results by tumour characteristics from a randomised trial

Manson

et al. 2008

Br J Cancer

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“…We calculated prediction interval (PI) of summary estimate for the random effects model to depict the uncertainty around the estimate (17). If studies did not report a summary risk estimate for aspirin use, a summary risk estimate was calculated using risk estimates for each of the aspirin use categories (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). Interstudy heterogeneity was estimated using a c 2 -based Q test (34), with a P value of <0.10 considered statistically significant (35).…”

Section: Discussionmentioning

confidence: 99%

Aspirin Use and Risk of Breast Cancer: Systematic Review and Meta-analysis of Observational Studies

Zhong

Chen

Zhang

et al. 2015

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Previous studies concerning the association between aspirin use and breast cancer risk yielded inconsistent results. We aimed to investigate the association by meta-analysis. PubMed and EMBASE were searched for relevant studies. We calculated the summary relative risks (RR) and 95% confidence intervals (CI) using random-effects models. Seventeen cohort studies and 15 case-control studies were included. The overall result showed that aspirin use decreased risk of breast cancer (RR, 0.90; 95% CI, 0.85-0.95). However, there was evidence of publication bias and heterogeneity and the association disappeared after correction using the trim-and-fill method. When stratified by study design, a significant benefit for aspirin users was only found in population-based and hospital-based casecontrol studies but not in cohort or nest case-control studies. Further subgroup analyses showed that aspirin use could decrease risk of in situ breast tumors or hormone receptorpositive tumors and reduce risk of breast cancer in postmenopausal women. Aspirin use may not affect overall risk of breast cancer, but decrease risk of in situ breast tumors or hormone receptor-positive tumors and reduce risk of breast cancer in postmenopausal women. Considering between-study significant heterogeneity and publication bias, confirmation in future studies is also essential.

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“…It is true that many of the observational studies of breast cancer risk relied on self-reporting of NSAID use. However, of four studies that used pharmacy or medical records, three reported an inverse association between NSAID use and breast cancer risk (12,20,22,23), suggesting that the inverse association is not limited to studies with self-reported data. Although dose is available in the Group Health automated pharmacy dispensing data, we were less confident that a dosespecific analysis would provide any additional information largely because many of these drugs are over the counter and we had no information on the actual dose women chose to take.…”

Section: Discussionmentioning

confidence: 99%

“…NSAIDs inhibit cyclooxygenase, which catalyzes the synthesis of prostaglandins; prostaglandin inhibition has reduced tumor formation in animal models (3,4). Many observational epidemiologic studies of aspirin and other NSAIDs and breast cancer risk have supported a reduction in risk usually in the range of 20% to 40% (1,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), although several prospective observational studies (24)(25)(26)(27) as well as prevention trials, like the Women's Health Study, have not (28). The inconsistencies across studies may be explained by real differences in dose and duration of NSAIDs across the studies and/or by reporting biases and residual confounding likely to be present in observational settings.…”

Section: Introductionmentioning

confidence: 99%

Nonsteroidal Anti-inflammatory Drugs and Change in Mammographic Density: A Cohort Study Using Pharmacy Records on Over 29,000 Postmenopausal Women

Terry

Buist

Trentham‐Dietz

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Use of nonsteroidal anti-inflammatory drugs (NSAID) has been associated with a decrease in breast cancer risk, but it is unknown if they also reduce mammographic density, a strong intermediate marker of breast cancer risk. Methods: We investigated NSAID use and mammographic density in 29,284 postmenopausal women who had two screening mammograms at Group Health in Seattle. We used pharmacy records to classify women as NSAID nonusers, continuers, initiators, or discontinuers based on use between the two mammograms and nine separate prescription and nonprescription NSAID classes. Using unordered polytomous logistic regression methods, we modeled the odds ratio (OR) of staying not dense, decreasing density, or increasing density relative to remaining dense based on Breast Imaging Reporting Data System classification of density.

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Association between frequent use of nonsteroidal anti-inflammatory drugs and breast cancer

Cited by 68 publications

References 33 publications

Low-dose aspirin and breast cancer risk: results by tumour characteristics from a randomised trial

Low-dose aspirin and breast cancer risk: results by tumour characteristics from a randomised trial

Aspirin Use and Risk of Breast Cancer: Systematic Review and Meta-analysis of Observational Studies

Nonsteroidal Anti-inflammatory Drugs and Change in Mammographic Density: A Cohort Study Using Pharmacy Records on Over 29,000 Postmenopausal Women

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