NSAID use & Cancer Mortality in Finland

[pjoshea13]

New study below [1].

I like these Nordic studies.  Researchers have access to records for everone.  No death escapes the database; ditto prescription drug use.  

Although the study was part of the Finnish Prostate Cancer Screening Trial, the scope was all cancer mortality & NSAID use.  80,144 men "aged 55–67 years from Tampere and Helsinki residential areas were identified from the population register".  "During the median follow-up time of 15 years, 7,008 men died from cancer."

"Men with prescription NSAID use had elevated cancer mortality {twice the risk} compared to non-users."  

{I don't know anything about otc NSAID availability in Finland, but prescription NSAIDs sound like like serious painkillers.  Perhaps prescribed for cancer pain?}

"When the usage during the last three years of follow-up was excluded, the effect was reversed"  A 31% reduction in mortality risk.

"Cancer mortality was not decreased for prescription or over-the-counter aspirin use."

"However, in the competing risk regression analysis combined prescription and over-the-counter aspirin use was associated with {24%} decreased overall cancer mortality"

Some quotes from the full text:

"Epidemiologic studies have estimated that more than 20% of all human cancer cases are associated with chronic inflammation. Inflammation has been thought to promote cancer by enhancing tumor cell proliferation and resistance to apoptosis. Inflammation also stimulates angiogenesis and tissue remodeling, which contributes to tumor cell invasion and progression ..."

{In my view, inflammation is not merely an artifact of cancer, useful for prognosis but little else.  Inflammation can be quantified & counteracted.  & it can be inhibited upstream by targeting cancer-related NF-kB activation.  Dealing with the problem downstream makes no sense.}

"Overall cancer mortality was not elevated in prescription aspirin users, when including usage during the entire follow-up (Table 3). However, in the lagged analysis, ongoing aspirin use was associated with an increased risk of cancer death (HR 1.31 ... in the analysis excluding aspirin use from the three final years). Furthermore, in the analysis for duration of use, the cancer mortality risk seems to decrease with duration of aspirin use (Table 3). When non-cancer mortality was included in the analysis as a competing risk, combined prescription and over-the-counter aspirin use was associated with decreased overall cancer mortality (HR 0.76 ...)"

"We found elevated cancer mortality among prescription NSAID and aspirin users. However, this was mostly explained by NSAID usage during the final years before death, as exclusion of medication use during the last three years of follow-up reversed the association to a protective level."

"The different results for aspirin and non-aspirin NSAIDs and cancer mortality in this study are most likely due to several factors. Firstly, indication of use is different for the drugs. Prescription aspirin was used in small dose combination (25mg) with dipyridamole for secondary prevention of vascular events. Prescription NSAIDs are used mainly for relief of pain and inflammatory symptoms and taken as needed. Secondly, the cancer preventive mechanism of aspirin has thought to be via the anti-platelet pathway. Circulating platelets play an important role in cancer progression and metastasis [34]. Aspirin inhibits platelet aggregation and it has been suggested that this could delay or even prevent cancer progression and metastasis."

{Finally, some confirmation of a possible effect of coagulation on metastasis!}

For those who read my post on the recent aspirin meta-analysis, & were perhaps dismayed by the benefit maybe kicking-in only after a few years - this could be related to the current study finding that protection was seen when the final 3 years was excluded.

-Patrick

[1]  journals.plos.org/plosone/a...

[jimreilly]

I'm on shaky ground here. It says "Prescription NSAIDs are used mainly for relief of pain and inflammatory symptoms and taken as needed."  Which means there's already inflammation present......so if there's a heightened chance of cancer now they'll have to try to find out if it's the inflammation or the NSAIDs that's contributing to the rate?