Nonsteroidal anti‐inflammatory drugs and risk of lung cancer

Abstract

Regular aspirin and non-aspirin nonsteroidal anti-inflammatory drug (NSAID) use is associated with a reduced risk of colorectal cancer. The effect of NSAIDs on the risk of other cancers remains unclear. To evaluate whether use of aspirin or other specific NSAIDs protects against lung cancer, we conducted a case-control study nested in a cohort of subjects 40-84 years old in 1995-2004, without a diagnosis of cancer before the study start date, and with at least 2 years of enrollment with a general practitioner providing data to the The Health Improvement Network (THIN) database in the UK. Patients who had a first diagnosis of primary lung cancer during the study period were considered cases. A random sample of 10,000 controls was frequency-matched to the cases for age, sex and calendar year. The index date for exposure definition was 1 year before the date of diagnosis for cases and 1 year before a random date within the study period for controls. Relative risks and 95% confidence intervals were estimated using conditional logistic regression stratified for matching factors. Factors such as smoking, chronic obstructive pulmonary disease, cardiovascular diseases and body mass index were introduced in the model. We identified 4,336 cases with primary incident lung cancer (incidence rate 7.6 per 10,000 person-years). Compared with subjects with no prescription of non-aspirin NSAID prior to the index date, the risk of lung cancer was 0.76 (0.61-0.94) among those who received a prescription the previous year and had a treatment duration of at least 1 year. The corresponding relative risk was 1.15 (0.99-1.34) for aspirin. In conclusion, prescription of non-aspirin NSAIDs for at least 1 year might be associated with a slightly reduced risk of lung cancer. Aspirin was not associated with a risk reduction, perhaps due to residual confounding. ' 2006 Wiley-Liss, Inc.

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

“…Fewer studies observed an increased risk of lung cancer for aspirin users. The only one with a significant result was a nested case-control study using the UK Health Improvement Network database in which a 53% increased risk of lung cancer was reported for men and women who received prescriptions for 150 mg or more per day of aspirin for at least 1 year (Hernandez-Diaz and Rodriguez, 2007). This increased risk is similar to what we observed for high quantity aspirin users in our cohort but the aspirin intake on which it was based is much lower.…”

“…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).…”

Combination regimen with statins and NSAIDs: A promising strategy for cancer chemoprevention

“…20 The use of NSAIDs was also linked to the protective effects against cancers in other sites such as breast, esophagus, stomach, lung, prostate and ovary. [21][22][23][24][25][26][27][28][29] However, the results for these cancer types are less consistent compared to those for colorectal cancer.…”

Use of NSAIDs, smoking and lung cancer risk

“…Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) used in relation to lung cancer have been investigated in at least 20 studies, including four hospital-based case -control studies (Rosenberg, 1995;Harris et al, 2002;Moysich et al, 2002;Muscat et al, 2003), fourteen cohort studies (Paganini-Hill et al, 1989;Thun et al, 1993;Schreinemachers and Everson, 1994;Langman et al, 2000;Akhmedkhanov et al, 2002;Friis et al, 2003;Holick et al, 2003;Sørensen et al, 2003;Ratnasinghe et al, 2004;Skriver et al, 2005;Hayes et al, 2006;Hernández-Diaz and Rodriguez, 2007;Jacobs et al, 2007;Wall et al, 2007) and three randomised trials (Peto et al, 1988;Lee et al, 1995;Cook et al, 2007). Significantly decreased risks were observed in three of the four hospital-based case -control studies (Rosenberg, 1995;Harris et al, 2002;Moysich et al, 2002), although all were based on selfreported drug use after diagnosis of cancer, raising the possibility of recall bias.…”

“…Significantly decreased risks were observed in three of the four hospital-based case -control studies (Rosenberg, 1995;Harris et al, 2002;Moysich et al, 2002), although all were based on selfreported drug use after diagnosis of cancer, raising the possibility of recall bias. Of the remaining studies in which drug details were obtained before diagnosis, only three found significant inverse associations, two (but with overlapping data) with regular aspirin use (Schreinemachers and Everson, 1994;Ratnasinghe et al, 2004) and a third with other NSAID use (Hernández-Diaz and Rodriguez, 2007). The remaining studies, including the three low-dose aspirin randomised trials (Peto et al, 1988;Lee et al, 1995;Cook et al, 2007) and a Danish cohort study that we previously reported (Skriver et al, 2005), revealed a modest, nonsignificantly decreased risk, no appreciable effect or an increased risk, respectively.…”