Association of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs with cancer incidence and mortality

Aditya Bardia, Jon Owen Ebbert, Robert A. Vierkant, Paul John Limburg, Kristin Anderson, Alice H. Wang, Janet E Olson, Celine M Vachon, James R Cerhan

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Abstract

Background: The cancer chemopreventive benefits of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) are incompletely defined and may vary by smoking history. We evaluated associations between aspirin and nonaspirin NSAID use with cancer incidence and mortality stratified by smoking history in the Iowa Women's Health Study, a prospective cohort of postmenopausal women. Methods: Aspirin and nonaspirin NSAID use was self-reported by questionnaire in 1992. Cancer incidence and mortality were ascertained by annual linkage to the Iowa Surveillance, Epidemiology, and End Results Cancer Registry and death certificates. Cox proportional hazards models were used to estimate multivariable relative risks (RRs) and 95% confidence intervals (CIs). All statistical tests were two-sided. Results: During an average of 10 years of follow-up, 3487 incident cancer cases and 3581 deaths were observed in the cohort of 22507 women. Compared with nonuse, aspirin use was inversely associated with total cancer incidence (multivariable-adjusted RR = 0.84, 95% CI = 0.77 to 0.90), with age-adjusted incidence rates of 147 and 170 per 10000 person-years for ever and never users, respectively, and was inversely associated with cancer mortality (multivariable-adjusted RR = 0.87, 95% CI = 0.76 to 0.99), with age-adjusted rates of 47 and 52 per 10000 person-years. The inverse relationship was stronger among former and never smokers than current smokers, although not statistically significantly (P = .28). Aspirin use was also inversely associated with coronary heart disease mortality (multivariable-adjusted RR = 0.75, 95% CI = 0.64 to 0.89), with age-adjusted rates of 23 and 30 per 10000 person-years for ever and never users, respectively, and with all-cause mortality (multivariable-adjusted RR = 0.82, 95% CI = 0.76 to 0.89), with age-adjusted rates of 126 and 155 per 10000 person-years. Nonaspirin NSAID use was not associated with cancer incidence or mortality, coronary heart disease mortality, or all-cause mortality. Conclusions: Aspirin use, but not nonaspirin NSAID use, was associated with lower risks of cancer incidence and mortality, which was more pronounced among former and never smokers than current smokers.

Original languageEnglish (US)
Pages (from-to)881-889
Number of pages9
JournalJournal of the National Cancer Institute
Volume99
Issue number11
DOIs
StatePublished - Jun 6 2007

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Aspirin
Anti-Inflammatory Agents
Mortality
Incidence
Pharmaceutical Preparations
Neoplasms
Confidence Intervals
Coronary Disease
Smoking
History
Death Certificates
Women's Health
Proportional Hazards Models
Registries
Epidemiology
Prospective Studies

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Association of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs with cancer incidence and mortality. / Bardia, Aditya; Ebbert, Jon Owen; Vierkant, Robert A.; Limburg, Paul John; Anderson, Kristin; Wang, Alice H.; Olson, Janet E; Vachon, Celine M; Cerhan, James R.

In: Journal of the National Cancer Institute, Vol. 99, No. 11, 06.06.2007, p. 881-889.

Research output: Contribution to journalArticle

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title = "Association of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs with cancer incidence and mortality",
abstract = "Background: The cancer chemopreventive benefits of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) are incompletely defined and may vary by smoking history. We evaluated associations between aspirin and nonaspirin NSAID use with cancer incidence and mortality stratified by smoking history in the Iowa Women's Health Study, a prospective cohort of postmenopausal women. Methods: Aspirin and nonaspirin NSAID use was self-reported by questionnaire in 1992. Cancer incidence and mortality were ascertained by annual linkage to the Iowa Surveillance, Epidemiology, and End Results Cancer Registry and death certificates. Cox proportional hazards models were used to estimate multivariable relative risks (RRs) and 95{\%} confidence intervals (CIs). All statistical tests were two-sided. Results: During an average of 10 years of follow-up, 3487 incident cancer cases and 3581 deaths were observed in the cohort of 22507 women. Compared with nonuse, aspirin use was inversely associated with total cancer incidence (multivariable-adjusted RR = 0.84, 95{\%} CI = 0.77 to 0.90), with age-adjusted incidence rates of 147 and 170 per 10000 person-years for ever and never users, respectively, and was inversely associated with cancer mortality (multivariable-adjusted RR = 0.87, 95{\%} CI = 0.76 to 0.99), with age-adjusted rates of 47 and 52 per 10000 person-years. The inverse relationship was stronger among former and never smokers than current smokers, although not statistically significantly (P = .28). Aspirin use was also inversely associated with coronary heart disease mortality (multivariable-adjusted RR = 0.75, 95{\%} CI = 0.64 to 0.89), with age-adjusted rates of 23 and 30 per 10000 person-years for ever and never users, respectively, and with all-cause mortality (multivariable-adjusted RR = 0.82, 95{\%} CI = 0.76 to 0.89), with age-adjusted rates of 126 and 155 per 10000 person-years. Nonaspirin NSAID use was not associated with cancer incidence or mortality, coronary heart disease mortality, or all-cause mortality. Conclusions: Aspirin use, but not nonaspirin NSAID use, was associated with lower risks of cancer incidence and mortality, which was more pronounced among former and never smokers than current smokers.",
author = "Aditya Bardia and Ebbert, {Jon Owen} and Vierkant, {Robert A.} and Limburg, {Paul John} and Kristin Anderson and Wang, {Alice H.} and Olson, {Janet E} and Vachon, {Celine M} and Cerhan, {James R}",
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T1 - Association of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs with cancer incidence and mortality

AU - Bardia, Aditya

AU - Ebbert, Jon Owen

AU - Vierkant, Robert A.

AU - Limburg, Paul John

AU - Anderson, Kristin

AU - Wang, Alice H.

AU - Olson, Janet E

AU - Vachon, Celine M

AU - Cerhan, James R

PY - 2007/6/6

Y1 - 2007/6/6

N2 - Background: The cancer chemopreventive benefits of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) are incompletely defined and may vary by smoking history. We evaluated associations between aspirin and nonaspirin NSAID use with cancer incidence and mortality stratified by smoking history in the Iowa Women's Health Study, a prospective cohort of postmenopausal women. Methods: Aspirin and nonaspirin NSAID use was self-reported by questionnaire in 1992. Cancer incidence and mortality were ascertained by annual linkage to the Iowa Surveillance, Epidemiology, and End Results Cancer Registry and death certificates. Cox proportional hazards models were used to estimate multivariable relative risks (RRs) and 95% confidence intervals (CIs). All statistical tests were two-sided. Results: During an average of 10 years of follow-up, 3487 incident cancer cases and 3581 deaths were observed in the cohort of 22507 women. Compared with nonuse, aspirin use was inversely associated with total cancer incidence (multivariable-adjusted RR = 0.84, 95% CI = 0.77 to 0.90), with age-adjusted incidence rates of 147 and 170 per 10000 person-years for ever and never users, respectively, and was inversely associated with cancer mortality (multivariable-adjusted RR = 0.87, 95% CI = 0.76 to 0.99), with age-adjusted rates of 47 and 52 per 10000 person-years. The inverse relationship was stronger among former and never smokers than current smokers, although not statistically significantly (P = .28). Aspirin use was also inversely associated with coronary heart disease mortality (multivariable-adjusted RR = 0.75, 95% CI = 0.64 to 0.89), with age-adjusted rates of 23 and 30 per 10000 person-years for ever and never users, respectively, and with all-cause mortality (multivariable-adjusted RR = 0.82, 95% CI = 0.76 to 0.89), with age-adjusted rates of 126 and 155 per 10000 person-years. Nonaspirin NSAID use was not associated with cancer incidence or mortality, coronary heart disease mortality, or all-cause mortality. Conclusions: Aspirin use, but not nonaspirin NSAID use, was associated with lower risks of cancer incidence and mortality, which was more pronounced among former and never smokers than current smokers.

AB - Background: The cancer chemopreventive benefits of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) are incompletely defined and may vary by smoking history. We evaluated associations between aspirin and nonaspirin NSAID use with cancer incidence and mortality stratified by smoking history in the Iowa Women's Health Study, a prospective cohort of postmenopausal women. Methods: Aspirin and nonaspirin NSAID use was self-reported by questionnaire in 1992. Cancer incidence and mortality were ascertained by annual linkage to the Iowa Surveillance, Epidemiology, and End Results Cancer Registry and death certificates. Cox proportional hazards models were used to estimate multivariable relative risks (RRs) and 95% confidence intervals (CIs). All statistical tests were two-sided. Results: During an average of 10 years of follow-up, 3487 incident cancer cases and 3581 deaths were observed in the cohort of 22507 women. Compared with nonuse, aspirin use was inversely associated with total cancer incidence (multivariable-adjusted RR = 0.84, 95% CI = 0.77 to 0.90), with age-adjusted incidence rates of 147 and 170 per 10000 person-years for ever and never users, respectively, and was inversely associated with cancer mortality (multivariable-adjusted RR = 0.87, 95% CI = 0.76 to 0.99), with age-adjusted rates of 47 and 52 per 10000 person-years. The inverse relationship was stronger among former and never smokers than current smokers, although not statistically significantly (P = .28). Aspirin use was also inversely associated with coronary heart disease mortality (multivariable-adjusted RR = 0.75, 95% CI = 0.64 to 0.89), with age-adjusted rates of 23 and 30 per 10000 person-years for ever and never users, respectively, and with all-cause mortality (multivariable-adjusted RR = 0.82, 95% CI = 0.76 to 0.89), with age-adjusted rates of 126 and 155 per 10000 person-years. Nonaspirin NSAID use was not associated with cancer incidence or mortality, coronary heart disease mortality, or all-cause mortality. Conclusions: Aspirin use, but not nonaspirin NSAID use, was associated with lower risks of cancer incidence and mortality, which was more pronounced among former and never smokers than current smokers.

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