NSAIDs to Prevent Breast Cancer Recurrence? An Unanswered Question.

A large body of evidence spanning preclinical, observational, and clinical data supports the potential use of nonsteroidal anti-inflammatory agents (NSAIDs) for cancer prevention, and possibly as adjuncts to cancer treatment. NSAIDs hold great ap-peal in this regard because they are relatively safe and inexpen-sive, and aspirin offers the potential to prevent, treat, or palliate several common, chronic, age-related diseases (eg, prevention of cardiovascular events, cancer risk reduction, treatment of in-flammatory conditions, pain management). To date, data sup-porting NSAID use for cancer risk reduction have been most compelling and consistent for colorectal cancer (CRC), where celecoxib and aspirin have shown efficacy in reducing the incidence of precancerous polyps and in reducing polyp/CRC incidence and mortality, respectively (1–3). Like CRC, breast cancer is a common cancer, with docu-mented overexpression of COX-2 and for which there is a need for more effective and affordable preventive and treatment strategies. Observational data are mixed but generally suggest that aspirin may improve breast cancer survival (4). Not surpris-ingly, data from large randomized controlled trials with breast cancer–specific outcomes are currently lacking for both aspirin and celecoxib. In this issue of the Journal, Strasser-Weippl et al. report on findings related to the use of celecoxib and aspirin in the National Cancer Institute of Canada Clinical Trials Group MA.27 trial (5). The authors conclude that neither celecoxib