Ovarian cancer risk may be reduced with regular use of low-dose aspirin while long-term, high-quantity use of other nonaspirin analgesics may increase the risk, according to a study published in JAMA Oncology.
A group of investigators from the Harvard T.H. Chan School of Public Health and Harvard Medical School conducted a cohort analysis using data from the Nurses’ Health Study (NHS) and the Nurses’ Health Study II (NHSII) to determine whether consistent use of aspirin or nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with risk of ovarian cancer.
The researchers evaluated NSAID use and ovarian cancer diagnosis in 93,664 women (average age at baseline, 45.9 years) in the NHS and 111,834 women (average age at baseline, 34.2) in the NHSII; 93% of participants from the NHS and 92% of participants from the NHSII self-identified as non-Hispanic white. A total of 1054 incident cases of epithelial ovarian cancer were recorded across 1,779,572 person-years in the NHS and 1,884,999 person-years in the NHSII.
Among women in both groups, current aspirin users were more inclined to use additional medications such as oral contraceptives and hormone therapy. In addition, current aspirin users were more likely to report cardiovascular events, hypertension, and chronic inflammatory diseases.
Isolated evaluations of low-dose (≤100 mg) and standard-dose (325 mg) aspirin resulted in a significant association with reduced ovarian cancer risk for low-dose aspirin (hazard ratio [HR], 0.77) and no significant association for standard-dose aspirin (HR, 1.17). There was no significant association with ovarian cancer risk when current vs nonuse of aspirin was evaluated regardless of dose (HR, 0.99).
The researchers reported a positive correlation between current nonaspirin NSAID use and ovarian cancer compared with nonuse (HR, 1.19) and a significant positive correlation for duration and cumulative average tablets per week. The results were inconclusive for acetaminophen.
“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,” the investigators concluded.
“Further exploration is warranted to evaluate the mechanism by which heavy use of aspirin, nonaspirin NSAIDs, and acetaminophen may contribute to the development of ovarian cancer and to replicate our findings,” added the authors. “Meanwhile, our results suggest that the 2016 US Preventive Services Task Force recommendation advising adults aged 50 to 59 years with a 10-year risk of cardiovascular disease greater than 10% to initiate low-dose aspirin therapy is unlikely to increase the risk of ovarian cancer.”
Barnard ME, Poole EM, Curhan GC, et al. Association of analgesic use with risk of ovarian cancer in the Nurses’ Health Studies [published online October 4, 2018]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.4149