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Gynecol Oncol. 2016 Aug;142(2):368-77. doi: 10.1016/j.ygyno.2016.04.543. Epub 2016 May 15.

Is aspirin use associated with a decreased risk of ovarian cancer? A systematic review and meta-analysis of observational studies with dose-response analysis.

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Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA. Electronic address:
Department of Science & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA.
Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China.



Currently available epidemiologic evidences concerning the chemopreventive effect of aspirin on ovarian cancer are inconsistent. Therefore, we aimed to further explore the association by synthesizing evidence from population-based studies.


We searched PubMed, EMBASE, Web of Science, and Scopus using key words and controlled vocabularies. Title/abstract screening, full-text review, data extraction, and quality assessment were performed independently by reviewers, and a random-effects model was utilized for meta-analysis. Subgroup analysis was conducted based on study locale, and sensitivity analysis was performed by synthesizing studies that adjusted for certain covariates or studies with good quality. Dose-response relation was assessed by a two-stage linear dose-response model. Statistical heterogeneity was evaluated by the I-squared value and a chi-squared test for the Cochrane Q statistic.


We identified 8 cohort studies and 15 case-control studies. In overall meta-analysis of risk ratios (RRs) of binary exposure, the synthesized RR was 0.89 (95% CI, 0.83-0.96), and no substantial statistical heterogeneity was observed (I(2)=22.5%, PCochrane=0.168). After stratification by study design, the synthesized RR was 0.85 (95% CI, 0.77-0.94) and 0.95 (95% CI, 0.85-1.05) for case-control and cohort studies, respectively. In sensitivity analysis, the synthesized estimate of long-term use was not statistically significant, whereas the effect measure (RRmeta=0.60, 95% CI, 0.39-0.93) was significant by synthesizing RRs of the highest frequency of use from 2 cohort studies. The dose-response analysis showed an inverse significant association between aspirin use and the risk (RRper 1time/wk=0.94, 95% CI, 0.89-1.00; n=2). Egger's tests showed that publication bias existed for overall meta-analysis, meta-analysis for case-control studies, and studies conducted in the United States.


In summary, our study suggests that aspirin can reduce the risk of ovarian cancer. In addition, we observed a possible dose-response relation between frequency of use and ovarian cancer risk, but further studies are needed to examine this association.


Aspirin; Chemoprevention; Ovarian cancer; Systematic review and meta-analysis

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