Low-dose Aspirin, Nonsteroidal Anti-inflammatory Drugs, Selective COX-2 Inhibitors and Breast Cancer Recurrence

Abstract

Background Aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), and selective COX-2 inhibitors may improve outcomes in breast cancer patients. We investigated the association of aspirin, NSAIDs, and use of selective COX-2 inhibitors with breast cancer recurrence. Methods We identified incident stage I–III Danish breast cancer patients in the Danish Breast Cancer Cooperative Group registry, who were diagnosed during 1996–2008. Prescriptions for aspirin (>99% low-dose aspirin), NSAIDs, and selective COX-2 inhibitors were ascertained from the National Prescription Registry (NPR). Follow-up began on the date of breast cancer primary surgery and continued until the first of recurrence, death, emigration, or 01/01/2013. We used Cox regression models to compute hazard ratios (HR) and corresponding 95% confidence intervals (95%CI) associating prescriptions with recurrence, adjusting for confounders. Results We identified 34,188 breast cancer patients with 233,130 person-years of follow-up. Median follow-up was 7.1 years; 5,325 patients developed recurrent disease. Use of aspirin, NSAIDs, or selective COX-2 inhibitors was not associated with the rate of recurrence (HRadjusted aspirin=1.0, 95% CI=0.90, 1.1; NSAIDs=0.99, 95% CI=0.92, 1.1; selective COX-2 inhibitors=1.1, 95% CI=0.98, 1.2), relative to non-use. Pre-diagnostic use of the exposure drugs was associated with reduced recurrence rates (HRaspirin=0.92, 95%CI=0.82, 1.0; HRNSAIDs=0.86, 95%CI=0.81, 0.91; HRsCOX-2inhibitors=0.88, 95%CI=0.83, 0.95). Conclusions This prospective cohort study suggests that post-diagnostic prescriptions for aspirin, NSAIDs, and selective COX-2 inhibitors have little or no association with the rate of breast cancer recurrence. Pre-diagnostic use of the drugs was, however, associated with a reduced rate of breast cancer recurrence.

Concurrent new drug prescriptions and prognosis of early breast cancer: studies using the Danish Breast Cancer Group clinical database

“…Our study of 34,188 breast cancer survivors showed no evidence of decreased recurrence rate associated with postdiagnostic aspirin, NSAIDs, or sCOX2 inhibitor use [13]. Our results were unchanged in stratified analyses and in analyses examining drug exposure and site-specific cancer recurrence.…”

“…Three cohort studies included patients diagnosed between 1996 and 2003 with follow-up through 2008 [10][11][12]. Later the cohorts were expanded to include patients diagnosed between 1996 and 2008 with follow-up through July 2013 [13][14][15]. Patients diagnosed with metastatic breast cancer were excluded from all studies.…”

Breast cancer recurrence after reoperation for surgical bleeding

“…Aspirin has been shown to decrease the risk of breast cancer mortality in some, but not all studies, whereas simvastatin has been consistently associated with a decreased risk of breast cancer recurrence/mortality. Information on prescribed aspirin was available, but it was not possible to account for aspirin bought over the counter.…”

Synergistic effect of nutlin-3 combined with aspirin in hepatocellular carcinoma HepG2 cells through activation of Bcl-2/Bax signaling pathway

“…The drug positively or negatively impact the clinical effect or plasma concentration of another drug even be a significant cause of morbidity and mortality worldwide. Aspirin inhibit the prevention, progression, and metastatic growth of cancer by the inhibition of COX-2 and platelet aggregation ( 34 – 36 ). The expression of COX-2 is associated with increased cell proliferation and tumor promotion significantly.…”