Nonsteroidal Anti-inflammatory Drugs and Risk of Esophageal and Gastric Adenocarcinomas in Los Angeles County
- 1Institute for Health Promotion and Disease Prevention Research, University of Southern California and 2Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, California
- Requests for reprints:
Leslie Bernstein, Division of Population Sciences, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010. Phone: 626-471-7315; Fax: 626-471-7308. E-mail: lbernstein{at}coh.org
Abstract
Background: Nonsteroidal anti-inflammatory drug (NSAID) use has been associated with a reduced risk of colon cancer; further epidemiologic data appear consistent for stomach and esophageal adenocarcinomas. Yet, data on potential confounding effects by upper gastrointestinal tract (UGI) disorders on adenocarcinomas of the UGI are limited.
Methods: This study recruited newly diagnosed patients with esophageal adenocarcinoma (n = 220), gastric cardia adenocarcinoma (n = 277), or distal gastric adenocarcinoma (n = 441) as well as 1,356 control subjects in Los Angeles County. Unconditional multivariable logistic regression analyses were done to evaluate the association between regular NSAID use, at least two pills per week for 1 month, and these cancers.
Results: Duration of regular use of aspirin and non-aspirin NSAIDs was associated with reduced relative odds of distal gastric adenocarcinoma [>5 years use versus no regular use: odds ratio (OR), 0.61; 95% confidence interval, 0.40-0.92; Ptrend = 0.009] and esophageal adenocarcinoma (OR, 0.60; 95% confidence interval, 0.38-0.95; Ptrend = 0.04) in multivariable models that included history of UGI disorders and other potential confounding factors. Daily regular use was also associated with statistically significant reduced ORs of these two tumor types. No significant heterogeneity in risk estimates was noted after stratification by history of UGI disorders for any of the sites studied. However, irregular users of NSAIDs also had reduced risk of these cancers when compared with nonusers.
Conclusions: Results from this study support an inverse association between regular NSAID use and risk of esophageal and distal gastric adenocarcinomas in individuals with and without a history of UGI disorders with long duration and daily use, providing the greatest risk reduction. Reduced risk in irregular users suggests that factors other than an effect on cyclooxygenase may also be important. (Cancer Epidemiol Biomarkers Prev 2008;17(1):126–34)
- esophageal adenocarcinoma
- gastric adenocarcinoma
- nonsteroidal anti-inflammatory drugs
- case-control study
Footnotes
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Grant support: California Tobacco Related Research Program grants 3RT-0122 and 10RT-0251, National Cancer Institute grant CA59636, and National Institute of Environmental Health Sciences grant 5P30 ES07048. Incident cancer cases for this study were collected by the University of Southern California Cancer Surveillance Program, which is supported under subcontract by the California Department of Health. The Cancer Surveillance Program is also part of the National Cancer Institute, Division of Cancer Prevention and Control's Surveillance, Epidemiology, and End Results program under contract N01CN25403.
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- Accepted October 24, 2007.
- Received July 23, 2007.
- Revision received September 21, 2007.
