Journal of the National Cancer Institute Advance Access originally published online on October 7, 2008
JNCI Journal of the National Cancer Institute 2008 100(20):1439-1447; doi:10.1093/jnci/djn324
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© The Author 2008. Published by Oxford University Press.
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Breast Cancer and Use of Nonsteroidal Anti-inflammatory Drugs: A Meta-analysis
Affiliations of authors: Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain (BT, CRM); Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The Lung Centre, Vancouver General Hospital, and Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada (ME)
Correspondence to: Bahi Takkouche, MD, PhD, Department of Preventive Medicine, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain (e-mail: mrbahi{at}usc.es).
Background: Breast cancer is one of the leading causes of mortality among women. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with reduced risk for breast cancer, but results from these studies of the association have been inconsistent.
Methods: Studies that examined the association between risk of breast cancer and use of NSAIDs, including aspirin and ibuprofen, that were published between January 1, 1966, and July 1, 2008, were identified using Medline, EMBASE, and other databases. We performed meta-analysis by pooling studies according to the inverse of their variances and performed separate analyses of studies pooled according to aspirin use and ibuprofen use. We evaluated publication bias and study quality.
Results: A total of 38 studies (16 case–control studies, 18 cohort studies, 3 case–control studies nested in well-defined cohorts, and 1 clinical trial) that included 2 788 715 subjects were identified. The results of these studies suggest that overall, NSAID use was associated with reduced risk for breast cancer (relative risk [RR] = 0.88, 95% confidence interval [CI] = 0.84 to 0.93). Specific analyses for aspirin (RR = 0.87, 95% CI = 0.82 to 0.92) and ibuprofen (RR = 0.79, 95% CI = 0.64 to 0.97) yielded similar results.
Conclusions: This meta-analysis provides evidence that NSAID use is associated with reduced risk for breast cancer. Future research should include careful evaluation of the biologic mechanisms involved in the relationship between NSAIDs and breast cancer.
| CONTEXT AND CAVEATS Prior knowledge Use of nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen, has been associated with reduced risk of breast cancer, but the results have been inconsistent. Study design Meta-analysis of cohort studies, case–control studies, and one clinical trial that examined the association between breast cancer risk and NSAID use. Contribution NSAID use was associated with a reduced risk for breast cancer. The inverse association was also observed in analyses of studies of aspirin or ibuprofen use alone. Implications NSAID use is associated with reduced risk for breast cancer. Limitations Limitations inherent in the designs of the studies used in the meta-analysis, such as recall bias. Behaviors that are associated with NSAID use that were not adjusted for might be associated with reduced risk of breast cancer. From the Editors
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Manuscript received May 2, 2008; revised July 17, 2008; accepted August 6, 2008.
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J Natl Cancer Inst 2008 100: 1420-1423.
J Natl Cancer Inst 2008 100: 1417.
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