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Risks of NSAID

More important to understand after recall of Vioxx and Bextra

Researchers have established a link between nonsteroidal anti-inflammatory drugs (NSAIDs) and breast cancer. NSAID have come under increasing scrutiny after the recall of Vioxx and Bextra (which are Cox-2 drugs) and the switch by millions of arthritis patients to NSAIDs.

A team lead by Sarah F. Marshall, at the Department of Preventive Medicine, University of Southern California, found that long-term daily use of NSAIDs was not associated with breast cancer risk overall. However, Ibuprofen use was associated with an increased risk of breast cancer, and long-term daily aspirin use was associated with an increased risk of ER/PR-negative breast cancer. It is not clear if the observed association is causal. In other words, more research may be needed to establish if NSAID actually cause cancer.

Epidemiologic studies of the association between non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, and breast cancer risk have yielded inconsistent results. The authors investigated the association of NSAID use with risk of breast cancer in the California Teachers Study cohort, with special attention to risk of specific breast cancer subtypes and to type of NSAID used. (Related article:  Pfizer to study Celebrex safety in PRECISION trial)

The researchers analyzed data on 114,460 women in the California Teachers Study cohort who were aged 22 to 85 years and free of breast cancer at baseline in 1995 to 1996. Information on frequency and duration of NSAID use was collected through a self-administered questionnaire. A total of 2391 women were diagnosed with breast cancer during the follow-up period from 1995 to 2001. (Related article:  Research proves that Cox-2 drugs do not protect stomach lining)

Picture of a bottle of painkiller ibuprofen.The results of the study showed that neither regular use (more than once a week) of any NSAID (aspirin and ibuprofen combined) nor regular use of aspirin was associated with breast cancer risk. However, long-term (5 years) daily aspirin users had a non–statistically significant decreased risk of estrogen receptor and progesterone receptor (ER/PR)–positive breast cancer. In contrast, the scientists observed a statistically significantly increased risk of ER/PR-negative breast cancer with long-term daily use of aspirin. In this population, 11 fewer ER/PR-positive breast cancer cases and seven excess ER/PR-negative breast cancer cases may be due to daily long-term aspirin use among 2391 breast cancer cases observed over 6 years if the association were proven to be causal.   (Related article:  Heart attack risks of Diclofenac and ibuprofen may force a recall of these drugs)

Long-term daily use of ibuprofen was also associated with an increased risk of breast cancer, particularly of non-localized tumors. If causality were subsequently proven, 16 of the observed 2391 breast cancer cases and 8 of the 713 non-localized breast cancer cases would be attributable to long-term daily use of ibuprofen. (Related: How to lower back pain)

Working with Sarah F. Marshall were Leslie Bernstein, Hoda Anton-Culver, Dennis Deapen, Pamela L. Horn-Ross, Harvey Mohrenweiser, David Peel, Rich Pinder, David M. Purdie, Peggy Reynolds, Dan Stram, Dee West, William E. Wright, Argyrios Ziogas, and Ronald K. Ross.

Researchers at the Royal Children's Hospital in Melbourne also studied adverse drug reactions over a five-year period to non steroidal anti-inflammatory drugs (NSAIDs), including COX-2 inhibitors, among children and have found that these drugs are causing significant adverse reactions in children, some life-threatening. Pediatrician Noel Cranswick, the lead researcher spoke to Australia's 7News correspondent Janelle Miles about the dangers of prescribing NSAIDs and Cox-2 inhibitor drugs to children.  According to another study by Anick Berard, Ph.D., of Sainte-Justine Hospital, women who took NSAID during early stages of their pregnancy had more than twice the risk of having babies with birth defects.

Recommended articles:  NSAID increase risks of heart attacks among smokers    Patient safety tips

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