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Aspirin and Other Nonsteroidal Anti-inflammatory Drugs and Breast Cancer Incidence in a Large U.S. Cohort

¹ Department of Epidemiology and Surveillance Research, American Cancer Society and ² Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia

Requests for reprints: Eric J. Jacobs, Department of Epidemiology and Surveillance Research, American Cancer Society, National Home Office, 1599 Clifton Road Northeast, Atlanta, GA 30329-4251. Phone: 404-329-7916; Fax: 404-327-6450. E-mail: Eric.Jacobs{at}cancer.org

Use of nonsteroidal anti-inflammatory drugs (NSAIDs), particularly aspirin, has consistently been associated with reduced risk of breast cancer in case-control studies. However, results from prospective studies have been less consistent. We examined the association between NSAID use and breast cancer incidence, adjusting for multiple breast cancer risk factors among 77,413 women in the Cancer Prevention Study II Nutrition Cohort. During follow-up from 1992 to 2001, we observed 3,008 cases of incident breast cancer. Information on NSAID use was obtained from a questionnaire completed at enrollment in 1992 or 1993 and was updated using follow-up questionnaires in 1997 and 1999. NSAID use was modeled using time-dependent variables to update exposure status. Neither current total NSAID use (aspirin and other NSAIDs combined) nor current aspirin use were associated with breast cancer incidence even at relatively high levels of use [rate ratio (RR), 1.07; 95% confidence interval (95% CI), 0.96-1.21 for 60 NSAID pills per month compared with no reported use of NSAIDs; RR, 1.01; 95% CI, 0.84-1.20 for 60 aspirin per month compared with no reported use of aspirin]. Even long-duration regular use (30 pills per month for 5 years) was not associated with breast cancer incidence (RR, 1.05; 95% CI, 0.88-1.26 for total NSAIDs; RR, 0.88; 95% CI, 0.69-1.12 for aspirin). Although we cannot exclude a small reduction in breast cancer risk associated with NSAID use, the results of this study provide evidence against a large reduction in risk.

Key Words: aspirin • NSAIDs • breast neoplasms • cohort study • epidemiology

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