Regular use of non-steroidal inflammatory drugs (NSAIDs) that are available over-the-counter (OTC) such as ibuprofen and aspirin, is associated with an increased risk of death in patients diagnosed with Type 1 endometrial cancers, according to a new study led by the Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).
A multi-institutional team of cancer researchers in this observational study, sought to understand the association of regular NSAID use and the risk of dying from endometrial cancer among a cohort of over 4,000 patients, reports News-Medical.net.
The researchers found that regular NSAID use was linked to a 66 percent increased risk of dying from endometrial cancer among women with Type 1 endometrial cancers, a typically less-aggressive form of the disease. The association was statistically significant among patients who reported past or current NSAID use at the time of diagnosis, but it was strongest among patients who had used NSAIDs for over 10 years in the past, but had stopped prior to diagnosis. Use of NSAIDs was not linked to mortality from typically more aggressive Type 2 cancers.
“There is 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,” says Theodore Brasky, PhD, co-lead author of the study and a cancer epidemiologist with the OSUCCC – James.
“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 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.”
Researchers note that information concerning specific dosages and NSAID use after surgery was not available in the current study, which represents a significant limitation.
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“We are continuing to analyze the biologic mechanisms by which inflammation is related to cancer progression in this specific cohort of patients,” adds Ashley Felix, PhD, co-lead author of the study and cancer epidemiologist with the OSUCCC – James and College of Public Health. They reported their findings in the December 16, 2016 issue of the Journal of the National Cancer Institute.
“These results are intriguing and worthy of further investigation,” says David Cohn, M.D., gynecologic oncology division director at the OSUCCC – James and co-author of the study. “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.”
Dr. Cohn says any woman concerned about risks of long-term NSAID use is advised to consult with her physician, reports News-Medical.net.
Researchers analyzed information from 4,374 endometrial cancer patients who previously participated in a national clinical trial for this study. All of the women were eligible for surgery and had not undergone prior surgery or radiation at the time of enrollment. Participants were tracked for an average of five years after enrollment.
Study participants were asked at the beginning of the study to fill out a questionnaire prior to surgery to get information about previous and current NSAID use including aspirin, non-aspirin (ibuprofen, naproxen, indomethacin, piroxicam, sulindac) and COX-2 inhibitors. Researchers gathered information about duration of use – ranging from less than one year to more than ten years – and whether that use was previous or current. Frequency of NSAID use, NSAID dosage, and use after surgery, were not available, according to News-Medical.net.
Researchers also collected clinical data (cancer stage, pathology, and treatment), demographic data (age, race, annual income, education) and information about established endometrial cancer risk factors, including body weight and height, reproductive and menstrual characteristics, history of hormone therapy, smoking status, and other medical conditions.
Researchers used regression models to statistically account for the influence of these additional factors on the association between NSAID use and endometrial cancer mortality.
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