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J Natl Cancer Inst. 2018 May 31. doi: 10.1093/jnci/djy100. [Epub ahead of print]

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

Author information

1
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
2
Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
3
Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA.
4
Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.
5
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
6
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
7
Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.
8
Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH.
9
Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
10
Epidemiology Research Program, American Cancer Society, Atlanta, GA.
11
Division of Genetics and Epidemiology and Division of Breast Cancer Research, The Institute of Cancer Research, London, UK.
12
City of Hope, Duarte, CA.
13
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
14
Department of Nutrition, University of California Davis, Davis, CA.
15
Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands.
16
National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.
17
Division of Epidemiology and Community Health, School of Public Health, and Masonic Cancer Center, University of Minnesota, Minneapolis, MN.
18
Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC.
19
University of Southern California, Los Angeles, CA.
20
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
21
Department of Research, Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway.
22
University of Hawaii Cancer Center, Honolulu, HI.
23
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.
24
Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.

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 (∼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.

PMID:
29860330
DOI:
10.1093/jnci/djy100

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