Jacobs EJ, Thun MJ, Bain EB, Rodriguez C, Henley SJ, Calle EEA large cohort study of long-term daily use of adult-strength aspirin and cancer incidence. J Natl Cancer Inst 99:608-615

Department of Epidemiology and Surveillance Research, American Cancer Society, National Home Office, 1599 Clifton Rd NE, Atlanta, GA 30329, USA.
Journal of the National Cancer Institute (Impact Factor: 12.58). 05/2007; 99(8):608-15. DOI: 10.1093/jnci/djk132
Source: PubMed


Epidemiologic evidence indicates that aspirin use is associated with reduced risks of colon cancer and possibly several other cancers, including prostate and breast cancers. Recent results from the Women's Health Study randomized trial indicate that long-term use of low-dose aspirin (100 mg every other day) does not substantially reduce cancer risk. However, the potential effect of long-term daily use of higher doses of aspirin on cancer incidence remains uncertain.
We examined associations between long-term daily use of adult-strength aspirin (> or = 325 mg/day) and both overall cancer incidence and incidence of 10 types of cancer among 69,810 men and 76,303 women participating in the Cancer Prevention Study II Nutrition Cohort, a relatively elderly population. Aspirin use was reported at enrollment in 1992-1993 and updated in 1997, 1999, and 2001. Multivariable Cox proportional hazards regression was used to calculate rate ratios (RRs).
During follow-up through June 2003, 10,931 men and 7196 women were diagnosed with cancer. Long-term (> or = 5 years) daily use of adult-strength aspirin, compared with no use, was associated with lower overall cancer incidence in men (multivariable-adjusted RR = 0.84, 95% confidence interval [CI] = 0.76 to 0.93) and non-statistically significantly lower overall cancer incidence in women (multivariable-adjusted RR = 0.86, 95% CI = 0.73 to 1.03). Overall cancer incidence per 100,000 person-years (standardized to the age distributions of men and women in the study) with long-term daily aspirin use and no aspirin use was 1858 and 2163, respectively, among men and 1083 and 1169, respectively, among women. Long-term daily aspirin use was associated with lower incidence of colorectal cancer (RR = 0.68, 95% CI = 0.52 to 0.90 among men and women combined) and prostate cancer (RR = 0.81, 95% CI = 0.70 to 0.94) and a non-statistically significant lower risk of female breast cancer (RR = 0.83, 95% CI = 0.63 to 1.10).
Long-term daily use of adult-strength aspirin may be associated with modestly reduced overall cancer incidence in populations among whom colorectal, prostate, and breast cancers are common.

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    • "Aspirin is the most commonly used anti-platelet agent in the primary and secondary prevention of cardiovascular events, with approximately 5% of middle-aged adults on long-term therapy [1]. Despite the clinical observations of a clustering of events following cessation of aspirin treatment, there are few prospective studies investigating the potential mechanisms. "

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    • "The studies that met the inclusion criteria were all observational studies, comprising 20 case–control [9-11,16,17,21-23,26,28-33,35-37,41],[44] and 19 cohort studies [7,8,12-15,18-20,24,25,27,34],[39,40,42,43,45,46] involving more than 924,502 male subjects, including 108,136 PCa cases. Thirty-one studies (18 case–control [9-11,16,17,21-23,26,28-33,35-37] and 13 cohort [7,8,12-15,18-20,24,25,27,34]) addressed the use of any NSAID and its association with PCa incidence risk (Table 1); eight studies (two case–control [41,44] and six cohort [39,40,42,43,45,46]) investigated whether NSAID use was associated with PCa-specific mortality (Table 2). For NSAID use and PCa incidence risk, the publication dates of the studies ranged between 1989 and 2014. "
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    ABSTRACT: It has been postulated that non-steroidal anti-inflammatory drugs (NSAIDs) use leads to decreased prostate cancer (PCa) risk. In recent years, NSAIDs' role in PCa development has been extensively studied; however, there is not yet a definitive answer. Moreover, the epidemiological results for NSAIDs' effect on PCa-specific mortality have been inconsistent. Therefore, we performed a meta-analysis to examine the controversy. We performed a literature database search and included all published studies conducted in the general population exposed to any NSAID, extracting an odds ratio (OR) or a hazard ratio (HR) with 95% confidence intervals (95% CIs) that compared the incidence of PCa or PCa-specific mortality with non-exposure. We derived a pooled OR or HR using random or fixed effects models, as appropriate. Subgroup analyses were also performed. Thirty-nine studies (20 case-control and 19 cohort studies) were included in this analysis. Thirty-one studies were available concerning NSAID use and PCa incidence and eight studies on PCa-specific mortality. Compared to non-use, aspirin use was statistically significantly associated with PCa incidence risk, and the association was slightly stronger for advanced PCa than for total PCa (OR = 0.92, 95% CI = 0.87 to 0.97 for total PCa; OR = 0.81, 95% CI = 0.73 to 0.89 for advanced PCa). Aspirin use seems also to be associated with a modest reduction in PCa-specific mortality (HR = 0.86, 95% CI = 0.78 to 0.96 for total PCa; OR = 0.81, 95% CI = 0.71 to 0.92 for advanced PCa). Generally, the pooled effects for any NSAIDs, NA-NSAIDs and cyclooxygenase-2 inhibitors demonstrated no adverse or beneficial effects on PCa development or PCa-specific mortality, but the results were not consistent. The effect estimates did not vary markedly when stratified by study design and study quality but varied by geographic region. Furthermore, long-term aspirin use (>=4 years) was also significantly associated with reduced PCa incidence (OR = 0.88, 95% CI 0.79 to 0.99). The present meta-analysis provides support for the hypothesis that aspirin use is inversely related to PCa incidence and PCa-specific mortality. The effect estimates, varying by geographic region, deserve further investigation.
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