Study Links NSAIDs to Higher Risk of Death from Endometrial CancerFeb 6, 2017
Study Looks at Drugs Like Aspirin, Ibuprofen and Cancer-Related Death
Patients who regularly use non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen may have a higher risk of dying from Type 1 endometrial cancers, a study published in the Journal of the National Cancer Institute suggests. Lead researchers from The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James) conducted a population-based study.
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The study involved data from over 4,000 patients. According to a Dec. 19, 2016 press release issued by The Ohio State University Comprehensive Cancer Center, there was a 66 percent increased risk of dying among women with Type 1 endometrial cancers who regularly used NSAIDs. Type 1 endometrial cancers are usually less aggressive than Type 2 cancers. The strongest link was among patients who had used NSAIDs for over a decade in the past but stopped using the drugs before being diagnosed with cancer.
Researchers found a statistically significant association between patients who reported past or current NSAID use at the time of diagnosis and a risk of dying from Type 1 endometrial cancers. The study did not find a relationship between death from Type 2 endometrial cancers and NSAID use.
"There is a increasing evidence that chronic inflammation is involved in endometrial cancer and progression and recent data suggests that inhibition of inflammation through NSAID use plays a role," said co-lead author Theodore Brasky, PhD, according to the release. "This study identifies a clear association that merits additional research to help us fully understand the biologic mechanisms behind this phenomenon. Our finding was surprising because it goes against previous studies that suggest NSAIDs can be used to reduce inflammation and reduce the risk of developing or dying from certain cancers, like colorectal cancer." Dr. Brasky is a cancer epidemiologist with the OSUCCC - James.
Ashley Felix, PhD, is also a co-lead author of the study and a cancer epidemiologist with the OSUCCC - James and College of Public Health. She commented, according to the release, "We are continuing to analyze the biologic mechanisms by which inflammation is related to cancer progression in this specific cohort of patients,"
The study was limited by the fact that authors could not obtain information about specific dosages and NSAID use after surgery.
Authors analyzed data from 4,374 women diagnosed with endometrial cancer. The participants had previously participated in a national clinical trial called NRG Oncology/GOG 210. These patients had not undergone prior surgery or radiation when they enrolled into the study, and were eligible for surgery. Researchers followed the participants for an average of five years after enrollment.
Before undergoing surgery, participants were given a questionnaire that included questions about past and current NSAID use. This includes medications such as aspirin, non-aspirin NSAIDs (ibuprofren, naproxen, indomethacin, piroxicam, sulinadac) and COX-2 inhibitors. Participants answered questions about how long they used NSAIDs. Some used the drugs for less than one year while others used NSAIDs for over 10 years. Researchers asked if the NSAID use was current or in the past. Specific information about daily frequency of NSAID use and dosage was not available.
Additionally, the authors gathered information about the patients’ cancer, demographic factors and risk factors for endometrial cancer. Researchers accounted for these factors in their statistical analysis to determine the relationship between NSAID use and the risk of dying from endometrial cancer.
"These results are intriguing and worthy of further investigation," said study co-author David Cohn, MD, gynecologic oncology division director at the OSUCCC - James. "It is important to remember that endometrial cancer patients are far more likely to die of cardiovascular disease than their cancer so women who take NSAIDs to reduce their risk of heart attack -- under the guidance of their physicians -- should continue doing so. While these data are interesting, there is not yet enough data to make a public recommendation for or against taking NSAIDS to reduce the risk of cancer-related death."
NSAID Warning Label Strengthened for Risk of Heart Attack, Stroke
Parker Waichman notes that the warning label on non-aspirin NSAIDs was strengthened in 2015 to warn about the risk of heart attack and stroke. According to a Jul. 9, 2015 Safety Announcement posted on the U.S. Food and Drug Administration (FDA) website, the agency has reviewed additional research findings on NSAIDs; new studies were also discussed in a February 2014 Arthritis Advisory Committee and Drug Safety and Risk Management Advisory Committee.
The label on NSAIDs (other than aspirin) already carried a warning for stroke and heart attack previously. This information was adjusted to warn that an NSAID can increase the risk of heart attack or stroke as early as the first weeks of use. The risk can increase with duration or higher doses, the revised label says.
Taking NSAIDs can increase the risk of stroke and heart attack even if patients have no history or risk factors for these conditions. "A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied," the FDA announcement states.
Additionally, evidence suggests that the risk of stroke and heart attack is not the same for all NSAIDs. However, there is not enough information to determine which drugs have the greatest risk.
Overall, patients with risk factors or a history of heart disease are more likely to suffer a stroke or heart attack with NSAID use since they are already at increased risk prior. "Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack," the FDA announcement said.
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