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Aspirin and NSAID use and lung cancer risk: a pooled analysis in the International Lung Cancer Consortium (ILCCO)

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Abstract

Purpose

To investigate the hypothesis that non-steroidal anti-inflammatory drugs (NSAIDs) lower lung cancer risk.

Methods

We analysed pooled individual-level data from seven case–control and one cohort study in the International Lung Cancer Consortium (ILCCO). Relative risks for lung cancer associated with self-reported history of aspirin and other NSAID use were estimated within individual studies using logistic regression or proportional hazards models, adjusted for packyears of smoking, age, calendar period, ethnicity and education and were combined using random effects meta-analysis.

Results

A total of 4,309 lung cancer cases (mean age at diagnosis 65 years, 45% adenocarcinoma and 22% squamous-cell carcinoma) and 58,301 non-cases/controls were included. Amongst controls, 34% had used NSAIDs in the past (81% of them used aspirin). After adjustment for negative confounding by smoking, ever-NSAID use (affirmative answer to the study-specific question on NSAID use) was associated with a 26% reduction (95% confidence interval 8 to 41%) in lung cancer risk in men, but not in women (3% increase (−11% to 30%)). In men, the association was stronger in current and former smokers, and for squamous-cell carcinoma than for adenocarcinomas, but there was no trend with duration of use. No differences were found in the effects on lung cancer risk of aspirin and non-aspirin NSAIDs.

Conclusions

Evidence from ILCCO suggests that NSAID use in men confers a modest protection for lung cancer, especially amongst ever-smokers. Additional investigation is needed regarding the possible effects of age, duration, dose and type of NSAID and whether effect modification by smoking status or sex exists.

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Acknowledgments

The ILCCO data management is supported by Canadian Cancer Society (CCSRI no. 020214) and Cancer Care Ontario Research Chair Award. Individual ILCCO studies were funded or supported by various institutions and organisations. NELCS: Grant Number P20RR018787 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH); MSKCC: Steps for Breath and the Labrecque Foundation, the Society of Memorial Sloan-Kettering Cancer Center. The authors would like to thank the following for their contribution with data management: Urvi Mujumdar and Radhai Rastogi (MSKCC) and Katja Boll (DDCHS).

Author information

Authors and Affiliations

  1. Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, 69008, Lyon, France

    Valerie A. McCormack

  2. Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Toronto, Canada

    Rayjean J. Hung & Darren R. Brenner

  3. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Rayjean J. Hung & Darren R. Brenner

  4. Department of Genetic Epidemiology Medical School, Georg-August-University of Göttingen, Göttingen, Germany

    Heike Bickeböller & Albert Rosenberger

  5. Pennsylvania State Cancer Institute, Pennsylvania State College of Medicine, Hersey, PA, USA

    Joshua E. Muscat & Philip Lazarus

  6. Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark

    Anne Tjønneland & Søren Friis

  7. Harvard School of Public Health, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

    David C. Christiani & Eun-mi Chun

  8. Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI, USA

    Loic Le Marchand

  9. Department of Community Medicine and Epidemiology, Carmel Medical Center and Bruce Rappaport Faculty of Medicine, Israel Institute of Technology and Clalit Health Services National Cancer Control Center, Haifa, Israel

    Gad Rennert & Hedy S. Rennert

  10. Norris Cotton Cancer Center, Department of Community & Family Medicine, Dartmouth Medical School, Lebanon, NH, USA

    Angeline S. Andrew

  11. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Irene Orlow & Bernard Park

  12. Hackensack University Medical Center, Hackensack, NJ, USA

    Bernard Park

  13. Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, NY, USA

    Paolo Boffetta

  14. International Prevention Research Institute, Lyon, France

    Paolo Boffetta

  15. Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain

    Eric J. Duell

Authors
  1. Valerie A. McCormack
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Correspondence to Valerie A. McCormack.

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McCormack, V.A., Hung, R.J., Brenner, D.R. et al. Aspirin and NSAID use and lung cancer risk: a pooled analysis in the International Lung Cancer Consortium (ILCCO). Cancer Causes Control 22, 1709–1720 (2011). https://doi.org/10.1007/s10552-011-9847-z

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  • DOI: https://doi.org/10.1007/s10552-011-9847-z

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