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© The Author 2007. Published by Oxford University Press.
ARTICLES |
Association of Aspirin and Nonaspirin Nonsteroidal Anti-inflammatory Drugs With Cancer Incidence and Mortality
Affiliations of authors: Departments of Internal Medicine (AB, JOE, PJL) and Health Sciences Research (RAV, AHW, JEO, CMV, JRC), Mayo Clinic College of Medicine, Rochester, MN; Department of Epidemiology, University of Minnesota, Minneapolis, MN (KA, CMV)
Correspondence to: Jon O. Ebbert, MD, Department of Internal Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905 (e-mail: ebbert.jon{at}mayo.edu).
Background: The cancer chemopreventive benefits of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) are incompletely defined and may vary by smoking history. We evaluated associations between aspirin and nonaspirin NSAID use with cancer incidence and mortality stratified by smoking history in the Iowa Women's Health Study, a prospective cohort of postmenopausal women.
Methods: Aspirin and nonaspirin NSAID use was self-reported by questionnaire in 1992. Cancer incidence and mortality were ascertained by annual linkage to the Iowa Surveillance, Epidemiology, and End Results Cancer Registry and death certificates. Cox proportional hazards models were used to estimate multivariable relative risks (RRs) and 95% confidence intervals (CIs). All statistical tests were two-sided.
Results: During an average of 10 years of follow-up, 3487 incident cancer cases and 3581 deaths were observed in the cohort of 22507 women. Compared with nonuse, aspirin use was inversely associated with total cancer incidence (multivariable-adjusted RR = 0.84, 95% CI = 0.77 to 0.90), with age-adjusted incidence rates of 147 and 170 per 10000 person-years for ever and never users, respectively, and was inversely associated with cancer mortality (multivariable-adjusted RR = 0.87, 95% CI = 0.76 to 0.99), with age-adjusted rates of 47 and 52 per 10000 person-years. The inverse relationship was stronger among former and never smokers than current smokers, although not statistically significantly (P = .28). Aspirin use was also inversely associated with coronary heart disease mortality (multivariable-adjusted RR = 0.75, 95% CI = 0.64 to 0.89), with age-adjusted rates of 23 and 30 per 10000 person-years for ever and never users, respectively, and with all-cause mortality (multivariable-adjusted RR = 0.82, 95% CI = 0.76 to 0.89), with age-adjusted rates of 126 and 155 per 10000 person-years. Nonaspirin NSAID use was not associated with cancer incidence or mortality, coronary heart disease mortality, or all-cause mortality.
Conclusions: Aspirin use, but not nonaspirin NSAID use, was associated with lower risks of cancer incidence and mortality, which was more pronounced among former and never smokers than current smokers.
| CONTEXT AND CAVEATS Prior knowledge The effectiveness of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) in cancer prevention is unclear. Study design Cohort study of aspirin and NSAID use, cancer incidence, and overall and coronary heart disease mortality among female residents of Iowa who participated in the Iowa Women's Health Study. Smoking history was also incorporated into the analyses. Contribution Nonaspirin NSAID use was not associated with any of the outcomes in the study. However, aspirin use was inversely associated with cancer incidence and cancer-related, coronary heart disease–related, and overall mortality. The associations were slightly but not statistically significantly stronger among former and never smokers than among current smokers. Implications Compared with no use, use of aspirin was associated with reduced cancer incidence and mortality in this population; no associations were observed with the use of nonaspirin NSAIDs. Limitations The survey-based design may be subject to usage reporting error, and specific information such as the dose and type of agent used was not reported. Because the study was restricted to postmenopausal mainly white women, it is unknown whether these results also apply to other populations.
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Manuscript received November 28, 2006; revised March 2, 2007; accepted April 20, 2007.
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J Natl Cancer Inst 2007 99: 825.
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