Analgesic Use and Ovarian Cancer Risk: An Analysis in the Ovarian Cancer Cohort Consortium.

Britton Trabert, Poole EM, White E, Kala Visvanathan, Adami HO, Anderson GL, Brasky TM, Brinton LA, Renée T. Fortner, Gaudet M, Hartge P, Hoffman-Bolton J, Michael E. Jones, Lacey JV, Larsson SC, Mackenzie GG, Leo J Schouten, Dale P. Sandler, O'Brien K, Patel AV, Peters U, Anna E. Prizment, Robien K, Setiawan VW, Anthony J. Swerdlow, Piet A van den Brandt, Elisabete Weiderpass, Wilkens LR, Wolk A, Wentzensen N, Shelley S. Tworoger
Journal of the National Cancer Institute · 2019 · doi:10.1093/jnci/djy100 · PMID:29860330 · PMC6376910
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This prospective analysis of 758,829 women found that daily aspirin use was associated with a modest reduction in ovarian cancer risk, while frequent long-term use of aspirin or nonaspirin NSAIDs showed no significant association.

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This prospective cohort analysis examined the association between analgesic use and ovarian cancer risk among 758,829 women, of whom 3,514 developed the disease. The results indicated that daily aspirin use was associated with a modest 10% reduction in ovarian cancer risk compared to infrequent or nonuse, whereas frequent use of nonaspirin NSAIDs or acetaminophen showed no significant protective effect. Daily acetaminophen use was linked to an elevated risk, while long-term frequent use of aspirin and nonaspirin NSAIDs suggested potentially elevated risks that were not statistically significant. This paper is centrally about ovarian cancer; relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

BackgroundAspirin use is associated with reduced risk of several cancers. A pooled analysis of 12 case-control studies showed a 10% decrease in ovarian cancer risk with regular aspirin use, which was stronger for daily and low-dose users. To prospectively investigate associations of analgesic use with ovarian cancer, we analyzed data from 13 studies in the Ovarian Cancer Cohort Consortium (OC3).MethodsThe current study included 758 829 women who at study enrollment self-reported analgesic use, among whom 3514 developed ovarian cancer. Using Cox regression, we assessed associations between frequent medication use and risk of ovarian cancer. Dose and duration were also evaluated. All statistical tests were two-sided.ResultsWomen who used aspirin almost daily (≥6 days/wk) vs infrequent/nonuse experienced a 10% reduction in ovarian cancer risk (rate ratio [RR] = 0.90, 95% confidence interval [CI] = 0.82 to 1.00, P = .05). Frequent use (≥4 days/wk) of aspirin (RR = 0.95, 95% CI = 0.88 to 1.03), nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs; RR = 1.00, 95% CI = 0.90 to 1.11), or acetaminophen (RR = 1.05, 95% CI = 0.88 to 1.24) was not associated with risk. Daily acetaminophen use (RR = 1.28, 95% CI = 1.00 to 1.65, P = .05) was associated with elevated ovarian cancer risk. Risk estimates for frequent, long-term (10+ years) use of aspirin (RR = 1.15, 95% CI = 0.98 to 1.34) or nonaspirin NSAIDs (RR = 1.19, 95% CI = 0.84 to 1.68) were modestly elevated, although not statistically significantly so.ConclusionsThis large, prospective analysis suggests that women who use aspirin daily have a slightly lower risk of developing ovarian cancer (∼10% lower than infrequent/nonuse)-similar to the risk reduction observed in case-control analyses. The observed potential elevated risks for 10+ years of frequent aspirin and NSAID use require further study but could be due to confounding by medical indications for use or variation in drug dosing.
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Abstract

Background Aspirin use is associated with reduced risk of several cancers. A pooled analysis of 12 case-control studies showed a 10% decrease in ovarian cancer risk with regular aspirin use, which was stronger for daily and low-dose users. To prospectively investigate associations of analgesic use with ovarian cancer, we analyzed data from 13 studies in the Ovarian Cancer Cohort Consortium (OC3).

Methods

The current study included 758 829 women who at study enrollment self-reported analgesic use, among whom 3514 developed ovarian cancer. Using Cox regression, we assessed associations between frequent medication use and risk of ovarian cancer. Dose and duration were also evaluated. All statistical tests were two-sided.

Results

Women who used aspirin almost daily (6 days/wk) vs infrequent/nonuse experienced a 10% reduction in ovarian cancer risk (rate ratio [RR] = 0.90, 95% confidence interval [CI] = 0.82 to 1.00, P = .05). Frequent use (4 days/wk) of aspirin (RR = 0.95, 95% CI = 0.88 to 1.03), nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs; RR = 1.00, 95% CI = 0.90 to 1.11), or acetaminophen (RR = 1.05, 95% CI = 0.88 to 1.24) was not associated with risk. Daily acetaminophen use (RR = 1.28, 95% CI = 1.00 to 1.65, P = .05) was associated with elevated ovarian cancer risk. Risk estimates for frequent, long-term (10+ years) use of aspirin (RR = 1.15, 95% CI = 0.98 to 1.34) or nonaspirin NSAIDs (RR = 1.19, 95% CI = 0.84 to 1.68) were modestly elevated, although not statistically significantly so.

Conclusions

This large, prospective analysis suggests that women who use aspirin daily have a slightly lower risk of developing ovarian cancer (approximate to 10% lower than infrequent/nonuse)similar to the risk reduction observed in case-control analyses. The observed potential elevated risks for 10+ years of frequent aspirin and NSAID use require further study but could be due to confounding by medical indications for use or variation in drug dosing. | Original language | English | |---|---| | Pages (from-to) | 137-145 | | Number of pages | 9 | | Journal | Journal of the National Cancer Institute | | Volume | 111 | | Issue number | 2 | | DOIs | | | Publication status | Published - Feb 2019 |

Keywords

- NONSTEROIDAL ANTIINFLAMMATORY DRUGS - LIFETIME OVULATORY CYCLES - LOW-DOSE ASPIRIN - BREAST-CANCER - PRIMARY PREVENTION - WOMENS HEALTH - ACETAMINOPHEN - INFLAMMATION - ASSOCIATION - DISEASE Fingerprint Dive into the research topics of 'Analgesic Use and Ovarian Cancer Risk: An Analysis in the Ovarian Cancer Cohort Consortium'. Together they form a unique fingerprint.Cite this - APA - Author - BIBTEX - Harvard - Standard - RIS - Vancouver

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