Abstract
Animal and in vitro studies suggest that aspirin may inhibit breast cancer metastasis. We studied whether aspirin use among women with breast cancer decreased their risk of death from breast cancer. This was a prospective observational study based on responses from 4,164 female registered nurses in the Nurses' Health Study who were diagnosed with stages I, II, or III breast cancer between 1976 and 2002 and were observed until death or June 2006, whichever came first. The main outcome was breast cancer mortality risk according to number of days per week of aspirin use (0, 1, 2 to 5, or 6 to 7 days) first assessed at least 12 months after diagnosis and updated. There were 341 breast cancer deaths. Aspirin use was associated with a decreased risk of breast cancer death. The adjusted relative risks (RRs) for 1, 2 to 5, and 6 to 7 days of aspirin use per week compared with no use were 1.07 (95% CI, 0.70 to 1.63), 0.29 (95% CI, 0.16 to 0.52), and 0.36 (95% CI, 0.24 to 0.54), respectively (test for linear trend, P < .001). This association did not differ appreciably by stage, menopausal status, body mass index, or estrogen receptor status. Results were similar for distant recurrence. The adjusted RRs were 0.91 (95% CI, 0.62 to 1.33), 0.40 (95% CI, 0.24 to 0.65), and 0.57 (95% CI, 0.39 to 0.82; test for trend, P = .03) for 1, 2 to 5, and 6 to 7 days of aspirin use, respectively. Among women living at least 1 year after a breast cancer diagnosis, aspirin use was associated with a decreased risk of distant recurrence and breast cancer death.
MeSH Terms
Adult
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
Anticarcinogenic Agents/therapeutic use
Aspirin/therapeutic use
Breast Neoplasms/mortality
Female
Humans
Middle Aged
Prospective Studies
Risk
Survival Analysis
Chemicals
Anti-Inflammatory Agents, Non-Steroidal
Anticarcinogenic Agents
Aspirin
Authors & Affiliations
6 authors, click to expand affiliations / ORCID
Holmes Michelle D
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
[email protected]
Chen Wendy Y
Li Lisa
Hertzmark Ellen
Spiegelman Donna
Hankinson Susan E
References (37)
37 references, click to expand
-
The modulating effects of flurbiprofen on adriamycin plus vincristine or vindesine in the treatment of advanced breast cancer.
Cancer Chemother Pharmacol. 1985;15(3):278-82
PMID: 3902268
-
A structural approach to selection bias.
Epidemiology. 2004 Sep;15(5):615-25
PMID: 15308962
-
Nonsteroidal anti-inflammatory drug use and breast cancer risk: a Danish cohort study.
Eur J Cancer Prev. 2008 Apr;17(2):88-96
PMID: 18287865
-
Aspirin and cancer risk: an updated quantitative review to 2005.
Cancer Causes Control. 2006 Sep;17(7):871-88
PMID: 16841255
-
Current antiplatelet therapies: benefits and limitations.
Am Heart J. 2008 Aug;156(2 Suppl):S3-9
PMID: 18657680
-
Aspirin use and breast cancer risk: a meta-analysis and meta-regression of observational studies from 2001 to 2005.
Pharmacoepidemiol Drug Saf. 2008 Feb;17(2):115-24
PMID: 17955496
-
Residual risk of breast cancer recurrence 5 years after adjuvant therapy.
J Natl Cancer Inst. 2008 Aug 20;100(16):1179-83
PMID: 18695137
-
In vitro capacity of various cyclooxygenase inhibitors to revert immune suppression caused by radiation therapy for breast cancer.
Radiother Oncol. 1990 Dec;19(4):329-35
PMID: 2126634
-
Phospholipid profiles of invasive human breast cancer cells are altered towards a less invasive phospholipid profile by the anti-inflammatory agent indomethacin.
Adv Enzyme Regul. 2000;40:271-84
PMID: 10828355
-
NSAID use and survival after breast cancer diagnosis in post-menopausal women.
Breast Cancer Res Treat. 2007 Jan;101(2):191-7
PMID: 16823508
-
The aspirin metabolite salicylate inhibits breast cancer cells growth and their synthesis of the osteolytic cytokines interleukins-6 and -11.
Anticancer Res. 1999 Jul-Aug;19(4B):2997-3006
PMID: 10652584
-
Host cyclooxygenase-2 modulates carcinoma growth.
J Clin Invest. 2000 Jun;105(11):1589-94
PMID: 10841517
-
Prospective study of regular aspirin use and the risk of breast cancer.
J Natl Cancer Inst. 1996 Jul 17;88(14):988-93
PMID: 8667430
-
Breast cancer and use of nonsteroidal anti-inflammatory drugs: a meta-analysis.
J Natl Cancer Inst. 2008 Oct 15;100(20):1439-47
PMID: 18840819
-
Nonsteroidal antiinflammatory drugs and breast cancer risk: the multiethnic cohort.
Am J Epidemiol. 2007 Nov 15;166(10):1150-8
PMID: 17698973
-
Low-dose aspirin in the primary prevention of cancer: the Women's Health Study: a randomized controlled trial.
JAMA. 2005 Jul 6;294(1):47-55
PMID: 15998890
-
A large cohort study of long-term daily use of adult-strength aspirin and cancer incidence.
J Natl Cancer Inst. 2007 Apr 18;99(8):608-15
PMID: 17440162
-
Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation.
N Engl J Med. 2001 Nov 8;345(19):1378-87
PMID: 11794170
-
NSAIDs and breast cancer recurrence in a prospective cohort study.
Cancer Causes Control. 2007 Aug;18(6):613-20
PMID: 17404892
-
Nonsteroidal anti-inflammatory drugs and breast cancer risk in the National Institutes of Health-AARP Diet and Health Study.
Breast Cancer Res. 2008;10(2):R38
PMID: 18447943
-
Breast cancer and NSAID use: a meta-analysis.
Br J Cancer. 2001 May 4;84(9):1188-92
PMID: 11336469
-
Use of inhibitors of prostaglandin synthesis in patients with breast cancer.
Adv Prostaglandin Thromboxane Res. 1980;6:511-6
PMID: 6992539
-
Low-dose aspirin and breast cancer risk: results by tumour characteristics from a randomised trial.
Br J Cancer. 2008 Mar 11;98(5):989-91
PMID: 18268496
-
Antiplatelet therapy for acute ischaemic stroke.
Cochrane Database Syst Rev. 2008 Jul 16;(3):CD000029
PMID: 18646056
-
Use of a marginal structural model to determine the effect of aspirin on cardiovascular mortality in the Physicians' Health Study.
Am J Epidemiol. 2002 Jun 1;155(11):1045-53
PMID: 12034583
-
The use of aspirin for primary prevention of colorectal cancer: a systematic review prepared for the U.S. Preventive Services Task Force.
Ann Intern Med. 2007 Mar 6;146(5):365-75
PMID: 17339622
-
Prostaglandins in breast cancer: relationship to disease stage and hormone status.
Br J Cancer. 1983 Nov;48(5):689-96
PMID: 6416285
-
Nonsteroidal anti-inflammatory drug use and serum total estradiol in postmenopausal women.
Cancer Epidemiol Biomarkers Prev. 2008 Mar;17(3):680-7
PMID: 18349287
-
Marginal structural models and causal inference in epidemiology.
Epidemiology. 2000 Sep;11(5):550-60
PMID: 10955408
-
Prostaglandins and breast cancer.
Lancet. 1977 Sep 24;2(8039):624-6
PMID: 71446
-
Elevated cyclooxygenase-2 expression correlates with distant metastases in breast cancer.
Anticancer Res. 2004 Jul-Aug;24(4):2349-51
PMID: 15330183
-
Phase II study of celecoxib and trastuzumab in metastatic breast cancer patients who have progressed after prior trastuzumab-based treatments.
Clin Cancer Res. 2004 Jun 15;10(12 Pt 1):4062-7
PMID: 15217939
-
NSAID use and breast cancer risk in the VITAL cohort.
Breast Cancer Res Treat. 2008 Jun;109(3):533-43
PMID: 17674199
-
Increased cyclooxygenase-2 (cox-2) expression and activity in a murine model of metastatic breast cancer.
Int J Cancer. 2001 Sep 1;93(5):681-6
PMID: 11477578
-
Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study.
Lancet. 2002 Apr 6;359(9313):1173-7
PMID: 11955534
-
Effect of highly active antiretroviral therapy on time to acquired immunodeficiency syndrome or death using marginal structural models.
Am J Epidemiol. 2003 Oct 1;158(7):687-94
PMID: 14507605
-
Marginal structural models to estimate the causal effect of zidovudine on the survival of HIV-positive men.
Epidemiology. 2000 Sep;11(5):561-70
PMID: 10955409