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Maintenance use of non-steroidal anti-inflammatory drugs and risk of gastrointestinal cancer in a nationwide population-based cohort study in Sweden.
- Source :
-
BMJ open [BMJ Open] 2018 Jul 07; Vol. 8 (7), pp. e021869. Date of Electronic Publication: 2018 Jul 07. - Publication Year :
- 2018
-
Abstract
- Objectives: Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are potential candidates for chemoprevention of gastrointestinal cancer. We aimed to assess the association between contemporary NSAID use (≥180 days) and gastrointestinal cancer.<br />Design: Nationwide Swedish population-based cohort study (2005-2012).<br />Setting: Sweden PARTICIPANTS: All adults exposed to maintenance NSAIDs use (aspirin, n=783 870; unselective NSAIDs, n=566 209, selective cyclo-oxygenase (COX)-2 inhibitors, n=17 948) compared with the Swedish background population of the same age, sex and calendar period.<br />Outcome Measures: The risk of different gastrointestinal cancer types expressed as standardised incidence ratios (SIR) and 95% CIs, taking into account concurrent proton pump inhibitors (PPIs) and statins usage.<br />Results: The SIR for gastrointestinal cancer for aspirin use was 1.02 (95% CI 1.00 to 1.04), with clearly reduced risk for long-term users (SIR=0.31, 95% CI 0.30 to 0.33 for 5.5-7.7 years), but an increased risk for short-term users (SIR=2.77, 95% CI 2.69 to 2.85), and stronger protective effect for low-dose aspirin (SIR=0.86, 95% CI 0.85 to 0.88). Users of non-selective NSAIDs showed an overall decreased risk of gastrointestinal cancer (SIR=0.79, 95% CI 0.77 to 0.82), in particular for cancer of the stomach, colorectum and oesophagus, and the SIRs were further decreased among long-term users. Users of selective COX-2 inhibitors showed a SIR=0.89 (95% CI 0.73 to 1.09) for gastrointestinal cancers. Both aspirin and unselective NSAIDs users who also were using PPIs, had higher risks for all gastrointestinal cancer types; and lower risk if using statins.<br />Conclusion: Long-term use of (low-dose) aspirin and non-selective NSAIDs was associated with a decreased risk of all gastrointestinal cancer types.<br />Competing Interests: Competing interests: None declared.<br /> (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Subjects :
- Adult
Aged
Anti-Inflammatory Agents, Non-Steroidal adverse effects
Aspirin adverse effects
Cohort Studies
Cyclooxygenase 2 Inhibitors adverse effects
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Gastrointestinal Hemorrhage pathology
Gastrointestinal Neoplasms chemically induced
Gastrointestinal Neoplasms epidemiology
Humans
Incidence
Male
Middle Aged
Proton Pump Inhibitors adverse effects
Risk Assessment
Risk Factors
Sweden epidemiology
Time Factors
Anti-Inflammatory Agents, Non-Steroidal administration & dosage
Aspirin administration & dosage
Chemoprevention
Cyclooxygenase 2 Inhibitors administration & dosage
Gastrointestinal Hemorrhage chemically induced
Gastrointestinal Neoplasms prevention & control
Proton Pump Inhibitors administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 2044-6055
- Volume :
- 8
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- BMJ open
- Publication Type :
- Academic Journal
- Accession number :
- 29982219
- Full Text :
- https://doi.org/10.1136/bmjopen-2018-021869