Aspirin use and mortality from cancer in a prospective cohort study.

UNLABELLED There is evidence that use of aspirin offers several potential health benefits including cancer prevention and cardiovascular disease prevention. The purpose of this study was to assess the association between aspirin use and death from cancer and cardiovascular diseases with a special emphasis on cancer mortality. MATERIALS AND METHODS The baseline data for this prospective cohort study were collected in 1971--1975 for the first National Health and Nutrition Examination Study (NHANES I) and 1976--1980 as part of the second NHANES (NHANES II) with mortality follow-up using the National Death Index (NDI) through December 31, 1992. The main analyses were the relative risks of total mortality and cause-specific mortality for persons who used aspirin compared to persons who did not use aspirin adjusted for confounding using Cox proportional hazards. RESULTS The proportion of aspirin users was lower among cancer cases than non-cases (58% versus 66%) and use of aspirin decreased with age. Consequently, age was a negative confounder attenuating the protective association between aspirin use and cancer and cardiovascular mortality. After adjusting for age, BMI, sex, race, poverty index, education and smoking, we observed a significant association of reduced all cause mortality among all aspirin users (relative risk [RR] = 0.88; 95% confidence interval [CI] 0.85 - 0.99) and lung cancer mortality among male aspirin users (RR = 0.69; CI 0.49-0.96). However, for women we observed adverse associations between aspirin use and bladder (RR=12.31; CI 2.98-50.80) and brain cancer mortality (RR=3.13; CI 1.09-9.00), although case numbers were small. CONCLUSION Aspirin use appears to offer protection from all causes of mortality and lung cancer among men. In women aspirin use is associated with increased risk of bladder and brain cancer. Because of the small number of female bladder (n=15) and brain (n=20) cancer cases in this cohort the findings require confirmation.

[1]  P. Taylor,et al.  Cyclooxygenase-2, P-glycoprotein-170 and drug resistance; is chemoprevention against multidrug resistance possible? , 2001, Anticancer research.

[2]  R. Lancashire,et al.  Effect of anti-inflammatory drugs on overall risk of common cancer: case-control study in general practice research database , 2000, BMJ : British Medical Journal.

[3]  J A Hanley,et al.  Nested caseÐcontrol study of the effects of non- steroidal anti-inflammatory drugs on breast cancer risk and stage , 2000 .

[4]  M. Yu,et al.  Non-steroidal anti-inflammatory drugs and bladder cancer prevention , 2000, British Journal of Cancer.

[5]  E. Hawk,et al.  Chemoprevention in hereditary colorectal cancer syndromes , 1999, Cancer.

[6]  D. Zaridze,et al.  Aspirin protects against gastric cancer: Results of a case‐control study from Moscow, Russia , 1999, International journal of cancer.

[7]  Sowmya R. Rao,et al.  The relationship of nonsteroidal anti-inflammatory drug use to the risk of breast cancer. , 1999, Preventive medicine.

[8]  W. Aronow.  Antiplatelet Agents in the Prevention of Cardiovascular Morbidity and Mortality in Older Patients With Vascular Disease , 1999, Drugs & aging.

[9]  E. Giovannucci.  The prevention of colorectal cancer by aspirin use. , 1999, Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie.

[10]  C. Loria,et al.  Plan and operation of the NHANES II Mortality Study, 1992. , 1999, Vital and health statistics. Ser. 1, Programs and collection procedures.

[11]  C. Hennekens.  Update on aspirin in the treatment and prevention of cardiovascular disease. , 1999, American heart journal.

[12]  D. Heitjan,et al.  Exisulind (sulindac sulfone) suppresses growth of human prostate cancer in a nude mouse xenograft model by increasing apoptosis. , 1999, Urology.

[13]  J. Morrow,et al.  Meloxicam inhibits the growth of colorectal cancer cells. , 1998, Carcinogenesis.

[14]  M. Taketo.  Cyclooxygenase-2 inhibitors in tumorigenesis (Part II). , 1998, Journal of the National Cancer Institute.

[15]  Y. Takei,et al.  Cyclooxygenase-2 inhibitors suppress the growth of gastric cancer xenografts via induction of apoptosis in nude mice. , 1998, The American journal of physiology.

[16]  J. Manson,et al.  Aspirin Use and Colorectal Cancer: Post-Trial Follow-up Data from the Physicians' Health Study , 1998, Annals of Internal Medicine.

[17]  M. Gammon,et al.  Use of aspirin and other nonsteroidal anti-inflammatory drugs and risk of esophageal and gastric cancer. , 1998, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[18]  M. Taketo.  Cyclooxygenase-2 inhibitors in tumorigenesis (part I). , 1998, Journal of the National Cancer Institute.

[19]  Y. Yazaki,et al.  Effects of sulindac on sporadic colorectal adenomatous polyps. , 1997, Gut.

[20]  G. Morgan.  Aspirin chemoprevention of colorectal and oesophageal cancers. An overview of the literature and homeopathic explanation. , 1996, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[21]  G. Colditz,et al.  Prospective study of regular aspirin use and the risk of breast cancer. , 1996, Journal of the National Cancer Institute.

[22]  E. Funkhouser,et al.  Aspirin and reduced risk of esophageal carcinoma , 1995, Cancer.

[23]  K. Namboodiri,et al.  Epidemiologic-study of nonsteroidal antiinflammatory drugs and breast-cancer. , 1995, Oncology reports.

[24]  P. Lavori,et al.  Effect of sulindac on sporadic colonic polyps. , 1995, Gastroenterology.

[25]  A. Paganini-Hill.  Aspirin and colorectal cancer: the Leisure World cohort revisited. , 1995, Preventive medicine.

[26]  J. Gelin,et al.  Anti-inflammatory treatment may prolong survival in undernourished patients with metastatic solid tumors. , 1994, Cancer research.

[27]  R. Everson,et al.  Aspirin Use and Lung, Colon, and Breast Cancer Incidence in a Prospective Study , 1994, Epidemiology.

[28]  R. Sampliner,et al.  NSAID effect on sporadic colon polyps. , 1993, The American journal of gastroenterology.

[29]  J. Manson,et al.  Low-dose aspirin and incidence of colorectal tumors in a randomized trial. , 1993, Journal of the National Cancer Institute.

[30]  M. Thun,et al.  Aspirin use and risk of fatal cancer. , 1993, Cancer research.

[31]  White Jg,et al.  Aspirin in ischemic heart disease--an overview. , 1993 .

[32]  J. F. Fraumeni,et al.  Incidence of cancer among patients with rheumatoid arthritis. , 1993, Journal of the National Cancer Institute.

[33]  J. White,et al.  Aspirin in ischemic heart disease--an overview. , 1993, Indian heart journal.

[34]  R. Kerbel,et al.  Cure of human melanoma lung metastases in nude mice with chronic indomethacin therapy combined with multiple rounds of IL-2: characteristics of killer cells generated in situ. , 1990, International immunology.

[35]  J. Feldman,et al.  Plan and operation of the NHANES I Epidemiologic Followup Study: 1982-84. , 1987, Vital and health statistics. Ser. 1, Programs and collection procedures.

[36]  Heneghan Jb.  Inhibition of human colon tumor growth in nude mice by indomethacin. , 1985 .

[37]  J. Heneghan.  Inhibition of human colon tumor growth in nude mice by indomethacin. , 1985, Progress in clinical and biological research.

[38]  P. Disaia,et al.  Response of human adenocarcinoma to chemotherapy: as sole agents and in combination with sodium ibuprofen. , 1984, Gynecologic oncology.

[39]  W. Waddell,et al.  Sulindac for polyposis of the colon , 1983, Journal of surgical oncology.

[40]  S. Handa,et al.  Urinary tract carcinoma in patients with analgesic nephropathy. , 1981, Nephron.

[41]  Handa Sp.  Analgesic nephropathy and urothelial carcinoma , 1979 .

[42]  S. Handa.  Analgesic nephropathy and urothelial carcinoma. , 1979, Canadian Medical Association journal.

[43]  S. Johansson,et al.  Malignancies of the urinary tract and their relation to analgesic abuse. , 1978, Kidney international.

[44]  L. J. Morin,et al.  Bladder tumor associated with phenacetin abuse. , 1977, Urology.

[45]  L. Angervall,et al.  Renal pelvic carcinoma in a Swedish district with abuse of a phenacetin-containing drug. , 1969, British journal of urology.

[46]  A. Ljungqvist,et al.  Carcinoma of the renal pelvis in renal papillary necrosis. , 1965, Acta chirurgica Scandinavica.