Use of aspirin, other nonsteroidal anti-inflammatory drugs and acetaminophen and risk of endometrial cancer: the Epidemiology of Endometrial Cancer Consortium

P M Webb; R Na; E Weiderpass; H O Adami; K E Anderson; K A Bertrand; E Botteri; T M Brasky; L A Brinton; C Chen; J A Doherty; L Lu; S E McCann; K B Moysich; S Olson; S Petruzella; J R Palmer; A E Prizment; C Schairer; V W Setiawan; A B Spurdle; B Trabert; N Wentzensen; L Wilkens; H P Yang; H Yu; H A Risch; S J Jordan

doi:10.1093/annonc/mdy541

Use of aspirin, other nonsteroidal anti-inflammatory drugs and acetaminophen and risk of endometrial cancer: the Epidemiology of Endometrial Cancer Consortium

Ann Oncol. 2019 Feb 1;30(2):310-316. doi: 10.1093/annonc/mdy541.

Authors

P M Webb¹, R Na², E Weiderpass³, H O Adami⁴, K E Anderson⁵, K A Bertrand⁶, E Botteri⁷, T M Brasky⁸, L A Brinton⁹, C Chen¹⁰, J A Doherty¹¹, L Lu¹², S E McCann¹³, K B Moysich¹³, S Olson¹⁴, S Petruzella¹⁴, J R Palmer⁶, A E Prizment⁵, C Schairer⁹, V W Setiawan¹⁵, A B Spurdle², B Trabert⁹, N Wentzensen⁹, L Wilkens¹⁶, H P Yang⁹, H Yu¹⁶, H A Risch¹², S J Jordan¹⁷

Affiliations

¹ Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, University of Queensland, Brisbane, Australia. Electronic address: penny.webb@qimrberghofer.edu.au.
² Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
³ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway; Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland; Faculty of Medicine, University of Helsinki, Helsinki, Finland.
⁴ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.
⁵ School of Public Health, University of Minnesota, Minneapolis, USA.
⁶ Slone Epidemiology Center, Boston University, Boston, USA.
⁷ Women and Children's Division, Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway; Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
⁸ Ohio State University Comprehensive Cancer Center, Columbus, USA.
⁹ Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA.
¹⁰ Fred Hutchinson Cancer Research Center, Seattle, USA.
¹¹ Fred Hutchinson Cancer Research Center, Seattle, USA; Huntsman Cancer Institute, University of Utah, Salt Lake City, USA; Huntsman Cancer Institute, University of Utah, Salt Lake City, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, USA.
¹² Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA.
¹³ Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, USA.
¹⁴ Memorial Sloan Kettering Cancer Center, New York, USA.
¹⁵ University of Southern California, Los Angeles, USA.
¹⁶ Epidemiology Program, University of Hawaii Cancer Center, Honolulu, USA.
¹⁷ Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, University of Queensland, Brisbane, Australia.

Abstract

Background: Regular use of aspirin has been associated with a reduced risk of cancer at several sites but the data for endometrial cancer are conflicting. Evidence regarding use of other analgesics is limited.

Patients and methods: We pooled individual-level data from seven cohort and five case-control studies participating in the Epidemiology of Endometrial Cancer Consortium including 7120 women with endometrial cancer and 16 069 controls. For overall analyses, study-specific odds ratios (ORs) and 95% confidence intervals (CI) were estimated using logistic regression and combined using random-effects meta-analysis; for stratified analyses, we used mixed-effects logistic regression with study as a random effect.

Results: At least weekly use of aspirin and non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with an approximately 15% reduced risk of endometrial cancer among both overweight and obese women (OR = 0.86 [95% CI 0.76-0.98] and 0.86 [95% CI 0.76-0.97], respectively, for aspirin; 0.87 [95% CI 0.76-1.00] and 0.84 [0.74-0.96], respectively, for non-aspirin NSAIDs). There was no association among women of normal weight (body mass index < 25 kg/m2, Pheterogeneity = 0.04 for aspirin, Pheterogeneity = 0.003 for NSAIDs). Among overweight and obese women, the inverse association with aspirin was stronger for use 2-6 times/week (OR = 0.81, 95% CI 0.68-0.96) than for daily use (0.91, 0.80-1.03), possibly because a high proportion of daily users use low-dose formulations. There was no clear association with use of acetaminophen.

Conclusion: Our pooled analysis provides further evidence that use of standard-dose aspirin or other NSAIDs may reduce risk of endometrial cancer among overweight and obese women.

Keywords: acetaminophen; aspirin; endometrial cancer; nonsteroidal anti-inflammatory drugs.

Publication types

Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't

MeSH terms

Acetaminophen / adverse effects*
Analgesics, Non-Narcotic / adverse effects*
Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
Aspirin / adverse effects*
Case-Control Studies
Cohort Studies
Endometrial Neoplasms / chemically induced
Endometrial Neoplasms / epidemiology*
Female
Follow-Up Studies
Humans
Prognosis
Risk Factors
United States / epidemiology

Substances

Analgesics, Non-Narcotic
Anti-Inflammatory Agents, Non-Steroidal
Acetaminophen
Aspirin

Abstract

Publication types

MeSH terms

Substances

Grants and funding