Effects of non-steroidal anti-inflammatory drugs on cancer sites other than the colon and rectum: a meta-analysis

González‐Pérez, Antonio; Rodrı́guez, Luis A. Garcı́a; López‐Ridaura, Ruy

doi:10.1186/1471-2407-3-28

Cited by 163 publications

(123 citation statements)

References 64 publications

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“…The other two studies found no effect (Egan et al, 1996;Anderson et al, 2002). The summary estimate for these studies is 0.78 (95% CI: 0.70, 0.86) (González-Pérez et al, 2003). As opposed to aspirin, long-term use of non-aspirin NSAIDs was not associated with a reduced risk of developing breast cancer in our study.…”

Section: Discussioncontrasting

confidence: 51%

“…Among the four studies that previously reported an estimate for non-aspirin NSAIDs, two of them found a negative result (Egan et al, 1996;Johnson et al, 2002) and the other two studies found a suggestion of a slight risk reduction (Coogan et al, 1999;Cotterchio et al, 2001). The summary estimate for these studies is 0.89 (0.79 -1.01) (González-Pérez et al, 2003). In our study, the indication among long-term users of aspirin was predominantly cardiovascular prevention.…”

Section: Discussionmentioning

confidence: 55%

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Risk of breast cancer among users of aspirin and other anti-inflammatory drugs

Rodrı́guez

González‐Pérez

2004

Br J Cancer

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We conducted a cohort study with a nested case -control analysis to evaluate the effect of anti-inflammatory drugs in breast cancer incidence using the General Practice Research Database. Women taking aspirin and paracetamol for 1 year or longer had an odds ratio (OR) of 0.77 (95 percent confidence interval (95% CI): 0.62,0.95) and 0.76 (95% CI: 0.65,0.88), respectively, compared to nonusers. Daily doses of aspirin (75 mg) and paracetamol (up to 2000 mg) showed the greatest reduced risk. Use of non-aspirin nonsteroidal anti-inflammatory drugs for more than 1 year was not associated with a reduced risk of breast cancer (OR ¼ 1.00 (95% CI: 0.84, 1.17), and the corresponding estimate among users with at least 2 years duration was similar. Our findings suggest that aspirin at cardioprophylactic doses as well as paracetamol at analgesic doses is associated with a reduced risk of breast cancer. There is mounting epidemiological evidence suggesting that nonsteroidal anti-inflammatory drugs (NSAIDs) may substantially reduce the risk of colorectal cancer (Thun et al, 1991;García Rodríguez and Huerta-Á lvarez, 2000). The effects of NSAIDs in other cancers have also been extensively studied in the last decade. Nonsteroidal anti-inflammatory drugs have been shown to prevent breast cancer in animal models (Lala et al, 1997;Robertson et al, 1998). Proposed mechanisms commonly involve the inhibition of cyclooxygenase-2 (COX-2) (Sjodahl, 2001), the enzyme responsible for the production of various prostaglandins that play a key role in the proliferation of tumour tissue; there is accumulating evidence that NSAIDs may have the ability to restore apoptosis and inhibit angiogenesis (Thun et al, 2002).Observational studies of the effect of NSAIDs in breast cancer have shown inconclusive results through a meta-analysis, including data from 15 studies that concluded that NSAIDs could be associated with a small decrease in risk (Khuder and Mutgi, 2001). However, the association between breast cancer incidence and glucocorticoid therapy has been hardly explored. Results from in vitro studies suggest that glucocorticoids have a direct inhibitory effect on proliferation of mammary cancer cells (Goya et al, 1993). However, to our knowledge, this hypothesis has not been tested in an epidemiological study.We conducted a cohort study with a nested caseÀcontrol analysis to evaluate the effect of anti-inflammatory drugs in breast cancer incidence using the General Practice Research Database (GPRD). MATERIALS AND METHODSWe used data from the GPRD. This database contains computerised information entered by general practitioners (GPs) in the UK (García Rodríguez and Pérez Gutthann, 1998). Data on over two million patients are systematically recorded and sent anonymously to the Medicines and Healthcare products Regulatory Agency (MHRA), which collects and organises this information in order to be used for research projects. The computerised information includes demographics, details from general practitioner's visits, diagnoses from specialist's re...

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Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 55%

Risk of breast cancer among users of aspirin and other anti-inflammatory drugs

Rodrı́guez

González‐Pérez

2004

Br J Cancer

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“…No evidence of a dose-response relationship was found and some studies indicated that coxibs were also associated with a lower risk of breast cancer [8]. This large-scale meta-analysis is consistent with several smaller meta-analyses [9][10][11][12].…”

Section: Introductionsupporting

confidence: 83%

Pre-surgical study of the biological effects of the selective cyclo-oxygenase-2 inhibitor celecoxib in patients with primary breast cancer

Martin

Davies

Weigel

et al. 2010

Breast Cancer Res Treat

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“…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.…”

mentioning

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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Effects of non-steroidal anti-inflammatory drugs on cancer sites other than the colon and rectum: a meta-analysis

Cited by 163 publications

References 64 publications

Risk of breast cancer among users of aspirin and other anti-inflammatory drugs

Risk of breast cancer among users of aspirin and other anti-inflammatory drugs

Pre-surgical study of the biological effects of the selective cyclo-oxygenase-2 inhibitor celecoxib in patients with primary breast cancer

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

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