Regular use of over-the-counter non-steroidal inflammatory drugs (NSAIDs) is associated with an increased risk of dying in patients diagnosed with type 1 endometrial cancers, according to a study published in the Journal of the National Cancer Institute.
For the observational study, Theodore Brasky, PhD, Ohio State University Comprehensive Cancer Center, Columbus, Ohio, and colleagues sought to understand the association of regular NSAID use and the risk of dying from endometrial cancer among a cohort of more than 4,000 patients.
They found that regular NSAID use was associated with a 66% increased risk of dying from endometrial cancer among women with type 1 endometrial cancers.
The association was significant among patients who reported past or current NSAID use at the time of diagnosis, but it was strongest among patients who had used NSAIDs for more than 10 years in the past but had ceased use prior to diagnosis.
Use of NSAIDs was not associated with mortality from typically more aggressive, type 2 cancers.
“There is an increasing evidence that chronic inflammation is involved in endometrial cancer and progression and recent data suggests that inhibition of inflammation through NSAID use plays a role,” said Dr. Brasky. “This study identifies a clear association that merits additional research to help us fully understand the biologic mechanisms behind this phenomenon. Our finding was surprising because it goes against previous studies that suggest NSAIDs can be used to reduce inflammation and reduce the risk of developing or dying from certain cancers, like colorectal cancer.”
The researchers pointed out that information about specific dosages and NSAID use after surgery was not available in the current study, which represents a significant limitation.
“We are continuing to analyse the biologic mechanisms by which inflammation is related to cancer progression in this specific cohort of patients,” said Ashley Felix, PhD, Ohio State University Comprehensive Cancer Center.
For the study, the researchers analysed information from 4,374 patients with endometrial cancer who previously participated in a national clinical trial (NRG Oncology/GOG 210). All of the women were eligible for surgery and had not undergone prior surgery or radiation at the time of enrolment. Participants were followed for an average of 5 years after enrolment.
Study participants were asked at the beginning of the study to complete a questionnaire prior to surgery to capture information about previous and current NSAID use including aspirin, non-aspirin NSAIDs, and COX-2 inhibitors. Researchers collected information about duration of use — ranging from <1 year to more than 10 years — and whether that use was previous or current. Daily frequency of NSAID use, NSAID dosage, and use after surgery were not available.
“These results are intriguing and worthy of further investigation,” said David Cohn, MD, Ohio State University Comprehensive Cancer Center. “It is important to remember that patients with endometrial cancer are far more likely to die of cardiovascular disease than their cancer so women who take NSAIDs to reduce their risk of heart attack — under the guidance of their physicians — should continue doing so. While these data are interesting, there is not yet enough data to make a public recommendation for or against taking NSAIDS to reduce the risk of cancer-related death.”