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Nonsteroidal Anti-inflammatory Drugs and Change in Mammographic Density: A Cohort Study Using Pharmacy Records on Over 29,000 Postmenopausal Women

¹ Department of Epidemiology, Mailman School of Public Health and ² Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York; ³ Group Health Center for Health Studies, Seattle, Washington; and ⁴ Department of Population Health Sciences and Paul P. Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, Wisconsin

Requests for reprints: Mary Beth Terry, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 724, New York, NY 10032. Phone: 212-305-4915; Fax: 212-305-9413. E-mail: mt146{at}columbia.edu

Background: Use of nonsteroidal anti-inflammatory drugs (NSAID) has been associated with a decrease in breast cancer risk, but it is unknown if they also reduce mammographic density, a strong intermediate marker of breast cancer risk.

Methods: We investigated NSAID use and mammographic density in 29,284 postmenopausal women who had two screening mammograms at Group Health in Seattle. We used pharmacy records to classify women as NSAID nonusers, continuers, initiators, or discontinuers based on use between the two mammograms and nine separate prescription and nonprescription NSAID classes. Using unordered polytomous logistic regression methods, we modeled the odds ratio (OR) of staying not dense, decreasing density, or increasing density relative to remaining dense based on Breast Imaging Reporting Data System classification of density.

Results: There was no association with density change from initiation or continuation of NSAIDs. However, both initiators and continuers of any NSAIDs were more likely to stay not dense than stay dense [OR, 1.12; 95% confidence interval (95% CI), 1.04-1.20; OR, 1.25; 95% CI, 1.05-1.49, respectively]. This association with staying not dense for initiators and continuers of any NSAID use was observed primarily among women ages <65 years at first mammogram (OR, 1.24; 95% CI, 1.12-1.36; OR, 1.48; 95% CI, 1.14-1.93, respectively).

Conclusions: Initiation of NSAID use did not reduce mammographic density over the short term. Continuers of NSAID use were more likely to stay not dense compared with nonusers, suggesting that it is plausible that longer-term use of NSAIDs may be needed to reduce density. (Cancer Epidemiol Biomarkers Prev 2008;17(5):1088–95)