The effect of NSAIDs exposure on breast cancer risk in female patients with autoimmune diseases

Abstract

Both breast cancer and autoimmune diseases (ADs) are predominant in women. NSAIDs are common medications for AD. Evidence on the association between NSAIDs use and breast cancer risk is controversial. We investigated the association between NSAIDs exposure and breast cancer risk in female patients with AD. AD patients older than 18 years of age were enrolled from Taiwan Longitudinal Health Insurance Database 2005. The NSAID users were defined as AD patients who had ever taken NSAIDs for at least 3 months between 2000 and 2009. All individuals were followed from the date of first diagnosis of AD to the end of 2013 to evaluate the risk of breast cancer. We estimated the adjusted hazard ratio (HR) using Cox proportional hazard regression after adjusting for age, comorbidities and medications. A total of 12 331 NSAID users and 12 331 non-NSAID users were included in this study after 1: 1 individual matching. The NSAID users were less likely to develop breast cancer than the non-NSAID users (adjusted HR: 0.37; 95% confidence interval: 0.27–0.50; P < 0.001), even if they used NSAIDs with low cumulative defined daily doses (adjusted HR: 0.42; 95% confidence interval: 0.34–0.53; P < 0.001). The incidence of new-onset breast cancer in NSAID users was significantly decreased in users taking selective cyclooxygenase 2 inhibitors, diclofenac, ibuprofen and piroxicam. Lower cumulative hazard rates were found in the AD patients who used NSAIDs (P < 0.001). NSAID exposure is associated with a decreased risk of breast cancer in female AD patients.

Use of nonsteroidal anti-inflammatory drugs and breast cancer risk in a prospective cohort of postmenopausal women

“…Our results are consistent with the majority of results from prospective studies, suggesting no reduced risk of breast cancer with NSAID use whether the exposure considered was any type of NSAIDs [ 12 , 27 – 29 ], high-dose aspirin [ 17 , 27 , 30 ], ibuprofen [ 27 , 31 , 32 ], COX-2 inhibitors [ 27 , 30 ], or non-aspirin NSAIDs [ 17 , 33 – 38 ]. However, some other studies have reported a reduced risk of breast cancer with NSAIDs (any type) [ 16 , 32 , 35 , 39 ], high-dose aspirin [ 32 ], ibuprofen [ 16 ], COX-2 inhibitors [ 11 , 14 , 16 , 39 ], or non-aspirin NSAIDs [ 29 , 30 , 40 , 41 ] while a few other studies indicated an increased risk of breast cancer with NSAIDs (any type) [ 10 , 31 ], high-dose aspirin [ 10 ], ibuprofen [ 10 ], or COX-2 inhibitors [ 13 , 15 ].…”

“…Among a dozen prospective studies with data on duration or dose of use, a few observed a dose/duration response [ 16 , 28 , 32 , 40 ]. In our study, the NSAID-breast cancer association did not differ according to duration or dose of use.…”

Biomarker expression analysis in different age groups revealed age was a risk factor for breast cancer

“…For example, the decrease in the incidence of BC in the early 21st century was, at least in part, related to the decline in the use of postmenopausal hormone therapy after the launch of the Women's Health Initiative trial (Ettinger, Quesenberry, Schroeder, & Friedman, ). In addition, older women seem to be more likely to take nonsteroidal anti‐inflammatory drugs (NSAIDs) as they age because of the onset of various diseases, and NSAID exposure has been shown to be associated with a decreased risk of BC (Hung et al, ). A worse prognosis may be related to the type of surgery performed.…”

Design, synthesis and anticancer evaluation of novel Se-NSAID hybrid molecules: Identification of a Se-indomethacin analog as a potential therapeutic for breast cancer

“…In this context, although nonsteroidal anti-inflammatory drugs (NSAIDs) have been traditionally known for their analgesic, anti-inflammatory and antipyretic effects [2], in recent years several epidemiological, preclinical, and clinical studies support their chemopreventive and chemotherapeutic potential use for cancer treatment [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Remarkably, numerous systematic reviews and meta-analyses to date suggest that NSAIDs could be associated with a reduced risk of breast cancer, particularly aspirin (ASA) [18][19][20][21][22][23][24][25]. Recently, ASA was shown to have a potential preventive effect especially in hormone receptor positive tumors or in situ breast tumors in postmenopausal women [8,21].…”