Breast Cancer and NSAID Use: Heterogeneity of Effect in a Case-Control Study

Harris, Rebecca; Namboodiri, K. K.; Sd, Stellman; El, Wynder

doi:10.1006/pmed.1995.1022

Cited by 59 publications

(31 citation statements)

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“…Within case-control studies, the reduction in risk was smaller in studies with cancer controls than in those with non-cancer controls. Although this finding is consistent with studies on NSAID use and colon cancer (Harris et al, 1995), it may argue against a true effect against breast cancer since this should be consistent across control groups. It is possible that some cancer subtypes (for example, gastrointestinal) were related to NSAID use and these patients discontinued the drug.…”

Section: Discussionsupporting

confidence: 86%

“…These drugs are often taken sporadically in a pattern of intake that may be difficult to remember or summarize for some subjects. For example, some widely used brands or combination product may not be recognized as containing aspirin (Harris et al, 1995). It is possible that NSAID use may reflect a health consciousness among the control group.…”

Section: Discussionmentioning

confidence: 99%

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Breast cancer and NSAID use: a meta-analysis

2001

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Recent epidemiological studies suggest that non-steroidal anti-inflammatory drugs (NSAIDs) reduce the risk of several cancers including breast cancer. This meta-analysis examined the studies on NSAID use and breast cancer. The estimators of relative risk and associated variances, which have been adjusted for the greatest number of confounders, were abstracted and included in the meta-analysis. Combined estimators of relative risk (RR) were calculated using either fixed or random effect models. Meta-analyses were performed on 6 cohort studies (number of cases ranged from 14 to 2414) and 8 case–control studies (number of cases ranged from 252 to 5882). The combined estimate of relative risk was 0.82 (95% confidence interval [CI] = 0.75–0.89). The combined estimate for cohort studies was 0.78 (95% CI = 0.62–0.99) and was 0.87 (95% CI = 0.84–0.91) for case–control studies. The findings of this meta-analysis suggest that NSAID use may be associated with a small decrease in the risk of breast cancer. However, the available data are insufficient to estimate the dose–response effect for duration and frequency of use of any particular types of NSAID. © 2001 Cancer Research Campaign http://www.bjcancer.com

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Breast cancer and NSAID use: a meta-analysis

2001

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“…'Large' indicates tumour size > 5 cm diameter or tumour with direct extension to the chest wall or skin, including inflammatory carcinoma. The ORs and their 95% Cls in the two columns on the right side of the table were derived from the analyses shown in The magnitude of the protective effect on risk that we observed at the highest level of exposure (Table 1, RR = 0.76, 95% CI 0.63-0.92) was comparable to that observed by others (Gridley et al, 1993;Schreinemachers and Everson, 1994;Friedman and Ury, 1980;Harris et al, 1995Harris et al, , 1996. However, some did not find similar effects.…”

Section: Interpretation Of Resultssupporting

confidence: 61%

“…The epidemiologic evidence for similar effects in women is limited and inconsistent (Isomäki et al, 1978;Friedman and Ury, 1980;Gridley et al, 1993;Thun et al, 1993;Schreinemachers and Everson, 1994;Harris et al, 1995Harris et al, , 1996Egan et al, 1996).To study the effects of NSAID use on breast cancer risk we carried out a nested case-control study, using the records of the Saskatchewan Cancer Agency (SCA) and data collected routinely by the Saskatchewan Prescription Drug Plan (SPDP), which has provided full or partial outpatient drug coverage to the Saskatchewan population since 1975.To study the effects of NSAID use on breast cancer growth and spread we carried out analyses using the drug exposure histories of the cases and attributes of the stage of their tumours at diagnosis, as assessed by the international tumour-lymph node-metastasis (TNM) system (Spiessl et al, 1992). …”

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confidence: 99%

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Nested case–control study of the effects of non-steroidal anti-inflammatory drugs on breast cancer risk and stage

et al. 2000

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Non-steroidal anti-inflammatory drugs (NSAIDs) interfere with the growth of mammary tumours (Lala et al, 1997;Robertson et al, 1998) and prevent distant metastasis (Hubbard et al, 1988;Khoo et al, 1992) in rodents. The epidemiologic evidence for similar effects in women is limited and inconsistent (Isomäki et al, 1978;Friedman and Ury, 1980;Gridley et al, 1993;Thun et al, 1993;Schreinemachers and Everson, 1994;Harris et al, 1995Harris et al, , 1996Egan et al, 1996).To study the effects of NSAID use on breast cancer risk we carried out a nested case-control study, using the records of the Saskatchewan Cancer Agency (SCA) and data collected routinely by the Saskatchewan Prescription Drug Plan (SPDP), which has provided full or partial outpatient drug coverage to the Saskatchewan population since 1975.To study the effects of NSAID use on breast cancer growth and spread we carried out analyses using the drug exposure histories of the cases and attributes of the stage of their tumours at diagnosis, as assessed by the international tumour-lymph node-metastasis (TNM) system (Spiessl et al, 1992). SUBJECTS AND METHODS Study populationsThe source population was the open population of women aged ≥ 35 years, eligible to receive benefits from the SPDP during 1981 to mid-1995 with no history of cancer since 1970 other than nonmelanoma skin cancer or cervical carcinoma in situ.Subjects entered the source population on 1 January 1981, their 35th birthday, or on the date of immigration to Saskatchewan, whichever occurred latest. Subjects left the source population on 30 June 1995, or on the date of diagnosis of breast cancer, death or emigration, whichever occurred first.The SPDP has provided coverage for outpatient prescription drugs for 94% of the Saskatchewan population (1.01 million people in mid-1991; Rawson et al, 1992). Excluded are aboriginals, military personnel, members of the Royal Canadian Mounted Police, and inmates of federal penitentiaries: they are covered by federal agencies. The accuracy of the identifying and recorded prescription information both exceed 99% (Risch and Howe, 1994).The cases were subjects in the source population who were diagnosed with histologically proven invasive female breast cancer and reported to the SCA. Registration of cancer cases was nearly complete (Parkin et al, 1997). To be in our study, cases must have been eligible to benefit from the SPDP for ≥ 5 years before diagnosis. Hereafter, the date of diagnosis will be designated as the 'index date'. Summary We carried out a nested case-control study to measure the rate ratio (RR) for invasive female breast cancer in relation to nonsteroidal anti-inflammatory drug (NSAID) use. The source population consisted of the female beneficiaries of the Saskatchewan Prescription Drug Plan from 1981 to 1995 with no history of cancer since 1970. Four controls/case, matched on age and sampling time, were randomly selected. Dispensing rates during successive time periods characterized NSAID exposure. RRs associated with exposure during each period we...

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Association of Frequency and Duration of Aspirin Use and Hormone Receptor Status With Breast Cancer Risk

Terry

Gammon

Zhang

et al. 2004

JAMA

249

134

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Context Use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with a decrease in the risk of several cancers, including breast cancer. NSAIDs inhibit cyclooxygenase activity and thereby reduce prostaglandin synthesis; prostaglandins stimulate aromatase gene expression and thereby stimulate estrogen biosynthesis. Given the importance of estrogen in the pathogenesis of breast cancer, the ability of aspirin and other NSAIDs to protect against breast cancer could vary according to hormone receptor status. Objectives To determine the association between the frequency and duration of use of aspirin and other NSAIDs and breast cancer risk and to investigate whether any observed association is more pronounced for women with hormone receptor-positive breast cancers. Design, Setting, and Patients Population-based case-control study of women with breast cancer, including in-person interviews conducted on Long Island, NY, during 1996-1997 (1442 cases and 1420 controls). Main Outcome Measure Incident invasive and in situ breast cancer by aspirin and NSAID use and hormone receptor status. Results Ever use of aspirin or other NSAIDs at least once per week for 6 months or longer was reported in 301 cases (20.9%) and 345 controls (24.3%) (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.66-0.97 for ever vs nonusers). The inverse association was most pronounced among frequent users (Ն7 tablets per week) (OR, 0.72; 95% CI, 0.58-0.90). The results for ibuprofen, which was used by fewer women on a regular basis, were generally weaker (OR, 0.78; 95% CI, 0.55-1.10 for Ͻ3 times per week vs OR, 0.92; 95% CI, 0.70-1.22 for Ն3 times per week). Use of acetaminophen, an analgesic that does not inhibit prostaglandin synthesis, was not associated with a reduction in the incidence of breast cancer. The reduction in risk with aspirin use was seen among those with hormone receptor-positive tumors (OR, 0.74; 95% CI, 0.60-0.93) but not for women with hormone receptor-negative tumors (OR, 0.97; 95% CI, 0.67-1.40). Conclusion These data add to the growing evidence that supports the regular use of aspirin and other NSAIDs (which may operate through inhibition of estrogen biosynthesis) as effective chemopreventive agents for breast cancer.

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Breast Cancer and NSAID Use: Heterogeneity of Effect in a Case-Control Study

Cited by 59 publications

References 0 publications

Breast cancer and NSAID use: a meta-analysis

Breast cancer and NSAID use: a meta-analysis

Nested case–control study of the effects of non-steroidal anti-inflammatory drugs on breast cancer risk and stage

Association of Frequency and Duration of Aspirin Use and Hormone Receptor Status With Breast Cancer Risk

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