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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.

Author information

1
Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA. Electronic address: dzhang34@live.unc.edu.
2
Department of Science & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
3
Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA.
4
Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China.

Abstract

OBJECTIVE:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

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

PMID:
27151430
DOI:
10.1016/j.ygyno.2016.04.543
[Indexed for MEDLINE]

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