Analgesic Use and Risk of Ovarian Cancer


Key Points

  • Low-dose aspirin was associated with a reduced risk of ovarian cancer.
  • Nonaspirin NSAID use appeared to be associated with an increased risk of ovarian cancer.

In an analysis of data from two Nurses’ Health Study cohorts reported in JAMA Oncology by Barnard et al, use of low-dose but not standard-dose aspirin was associated with reduced risk of epithelial ovarian cancer, whereas use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) appeared to be associated with an increased risk.

Study Details

The study involved data from 93,664 women in the Nurses’ Health Study I (NHSI) followed from 1980 to 2014 (mean age at baseline = 45.9 years) and 111,834 from the Nurses’ Health Study II (NHSII) followed from 1989 to 2015 (mean age at baseline = 34.2 years). Data on the use of aspirin, low-dose aspirin, nonaspirin NSAIDs, and acetaminophen including timing, duration, frequency, and number of tablets were evaluated with updates performed every 2 to 4 years.

Regular use of these analgesics was defined as ≥ 2 times per week. Models accounted for variation in baseline hazards by cohort, age in months (continuous), and calendar years (continuous), with multivariate analysis also adjusting for menopausal status, parity, duration of oral contraceptive use, duration of postmenopausal hormone therapy by type, history of tubal ligation, history of hysterectomy, family history of breast or ovarian cancer, and body mass index.

Associations With Analgesic Use

Among the 205,498 women, representing 1,779,572 person-years in the NHSI and 1,884,999 person-years in the NHSII, there were 1,054 incident cases of epithelial ovarian cancer. No significant association for current use vs nonuse of any aspirin dose was observed for risk of ovarian cancer regardless of dose (hazard ratio [HR] = 0.99, 95% confidence interval [CI] = 0.83–1.19).

In a separate analysis, the use of low-dose aspirin (≤ 100 mg) was associated with an reduced risk of disease (HR = 0.77, 95% CI = 0.61–0.96), whereas standard-dose aspirin was associated with a nonsignificant increase in risk (HR = 1.17, 95% CI = 0.92–1.49). No difference in risk with low-dose aspirin was observed for longer duration of use (≥ 5 vs <1 year, HR = 0.92, 95% CI = 0.57–1.48; P = .41 for trend), with a positive trend of greater risk with longer use being observed for standard-dose aspirin (for ≥ 5 vs < 1 year, HR = 1.77, 95% CI = 1.13–2.77; P = .004 for trend).

Current use of nonaspirin NSAIDs was positively associated with risk of ovarian cancer compared with nonuse (HR = 1.19, 95% CI = 1.00–1.41), with significant positive trends for duration of use (P = .02 for trend; eg, HR = 1.34, 95% CI = 1.06–1.70, for ≥ 10 years vs no regular use) and cumulative average tablets per week (P = .03 for trend; eg, HR = 1.35, 95% CI = 1.02–1.79, for average of ≥ 10 vs < 1 tablets per week).

No clear associations of acetaminophen use and risk of cancer were identified.

The investigators concluded, “These results appear to be consistent with case-control studies that show a reduced risk of ovarian cancer among regular users of low-dose aspirin. An increased risk of ovarian cancer with long-term high-quantity use of other analgesics, particularly nonaspirin NSAIDs, was observed, although this finding requires confirmation.”

The work was supported by grants from the National Cancer Institute and National Institutes of Health.

Mollie E. Barnard, ScD, of the Department of Epidemiology, Harvard T.H. Chan School of Public Health, is the corresponding author for the JAMA Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.