Colorectal cancer after start of nonsteroidal anti-inflammatory drug use |
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Authors: | Stürmer Til Buring Julie E Lee I-Min Kurth Tobias Gaziano J Michael Glynn Robert J |
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Institution: | a Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass b Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass c Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, Mass d Department of Epidemiology, Harvard School of Public Health, Boston, Mass e Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass f Massachusetts Veterans Epidemiology Research and Information Center, Boston VA Health Care System, Boston, Mass g Department of Biostatistics, Harvard School of Public Health, Boston, Mass. |
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Abstract: | PurposeNonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, have been consistently shown to reduce the risk of colorectal cancer (CRC) in non-experimental studies, but little is known of the factors associated with starting and continuing regular NSAID use and their effect on the NSAID and CRC association.Subjects and methodsWe performed a prospective cohort study of 22,071 healthy male physicians aged 40 to 84 years without indications or contraindications to regular NSAID use at baseline. Annual questionnaires assessed quantity of NSAID use, occurrence of cancer, and risk factors for CRC. Propensity for regular NSAID use (>60 days/year) was estimated using generalized estimating equations. We used a time-varying Cox proportional hazards model to estimate the association between duration since initiation of regular NSAID use and risk for CRC.ResultsRegular non-aspirin and any NSAID use increased from 0% to 12% and 1% to 56% over time, respectively and was predicted by age, body mass index, alcohol consumption, medication use, coronary artery disease, gastrointestinal diseases, arthritis, hypertension, and headaches. Over a median follow-up of 18 years, 495 physicians were diagnosed with CRC. There was no trend of CRC risk with increased duration of regular NSAID use. Five or more years of regular use of any NSAID were associated with a relative risk for CRC of 1.0 (95% confidence interval: 0.7-1.5), after adjustment for predictors of regular NSAID use.ConclusionRegular NSAID use was not associated with a substantial risk reduction of CRC after controlling for time-varying predictors of both NSAID use and CRC. |
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Keywords: | Colorectal neoplasms Anti-inflammatory agents Nonsteroidal Selection bias Confounding factors (epidemiology) Pharmacoepidemiology Epidemiology Chemoprevention |
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