Skip to main content

Advertisement

Log in

Association between aspirin use and mortality in breast cancer patients: a meta-analysis of observational studies

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Previous studies have examined the effect of aspirin intake on the mortality in breast cancer, but the results are inconsistent. A meta-analysis was performed to assess the association with all available studies. Relevant studies were identified by searching PubMed and EMBASE to November 2014. We calculated the summary relative risks (RRs) and 95 % confidence intervals (CIs) using random-effects models. For this meta-analysis, eight cohort studies and two nested case–control studies were included. The analysis included 26,931 participants for postdiagnosis aspirin use and 673,453 participants for prediagnosis aspirin use, followed up over a period of between 2.6 and 30 years. The results showed that patients who used aspirin after diagnosis had a RR of 0.73 (95 % CI = 0.54–0.98, P = 0.04) for breast cancer-specific mortality compared to those who did not use aspirin. Those who used aspirin after diagnosis (vs. non-users) had a RR of 0.84 (95 % CI = 0.63–1.12, P = 0.24) for all-cause mortality. Prediagnostic exposure to aspirin was associated with neither breast cancer-specific mortality (RR = 1.04, 95 % CI = 0.75–1.45, P = 0.80) nor all-cause mortality (RR = 1.04, 95 % CI = 0.61–1.78, P = 0.89). Significant heterogeneity among included studies may be due to a single study, after removing which the significant association between postdiagnosis aspirin use and breast cancer-specific mortality disappeared; however, prediagnosis aspirin use achieved a borderline significant association with risk of all-cause mortality (RR = 0.81, 95 % CI = 0.68–0.97, P = 0.03). In conclusion, aspirin use might has, if any, only a small effect on the survival of breast cancer patients based on current evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Siegel R, Ma J, Zou Z, Jemal A (2014) Cancer statistics, 2014. CA Cancer J Clin 64(1):9–29. doi:10.3322/caac.21208

    Article  PubMed  Google Scholar 

  2. Blair CK, Sweeney C, Anderson KE, Folsom AR (2007) NSAID use and survival after breast cancer diagnosis in post-menopausal women. Breast Cancer Res Treat 101(2):191–197. doi:10.1007/s10549-006-9277-x

    Article  CAS  PubMed  Google Scholar 

  3. Holmes MD, Chen WY, Li L, Hertzmark E, Spiegelman D, Hankinson SE (2010) Aspirin intake and survival after breast cancer. J clin oncol 28(9):1467–1472. doi:10.1200/jco.2009.22.7918

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Fraser DM, Sullivan FM, Thompson AM, McCowan C (2014) Aspirin use and survival after the diagnosis of breast cancer: a population-based cohort study. Br J Cancer 111(3):623–627. doi:10.1038/bjc.2014.264

    Article  CAS  PubMed  Google Scholar 

  5. Thorat MA, Cuzick J (2013) Role of aspirin in cancer prevention. Curr Oncol Rep 15(6):533–540. doi:10.1007/s11912-013-0351-3

    Article  CAS  PubMed  Google Scholar 

  6. Ye XF, Wang J, Shi WT, He J (2014) Relationship between aspirin use after diagnosis of colorectal cancer and patient survival: a meta-analysis of observational studies. Br J Cancer. doi:10.1038/bjc.2014.481

    Google Scholar 

  7. Wells G, Shea B, O’Connell D, Robertson J, Peterson J, Welch V, Losos M, Tugwell P (2010) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. www.ohri.ca/programs/clinical_epidemiology/oxford_web.ppt

  8. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188. doi:10.1016/0197-2456(86)90046-2

    Article  CAS  PubMed  Google Scholar 

  9. Holmes MD, Olsson H, Pawitan Y, Holm J, Lundholm C, Andersson TM, Adami HO, Askling J, Smedby KE (2014) Aspirin intake and breast cancer survival—a nation-wide study using prospectively recorded data in Sweden. BMC Cancer 14(1):391. doi:10.1186/1471-2407-14-391

    Article  PubMed Central  PubMed  Google Scholar 

  10. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. doi:10.1002/sim.1186

    Article  PubMed  Google Scholar 

  11. Hedges LV, Pigott TD (2001) The power of statistical tests in meta-analysis. Psychol Methods 6(3):203–217

    Article  CAS  PubMed  Google Scholar 

  12. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Bardia A, Ebbert JO, Vierkant RA, Limburg PJ, Anderson K, Wang AH, Olson JE, Vachon CM, Cerhan JR (2007) Association of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs with cancer incidence and mortality. J Natl Cancer Inst 99(11):881–889. doi:10.1093/jnci/djk200

    Article  CAS  PubMed  Google Scholar 

  14. Allott EH, Tse CK, Olshan AF, Carey LA, Moorman PG, Troester MA (2014) Non-steroidal anti-inflammatory drug use, hormone receptor status, and breast cancer-specific mortality in the Carolina Breast Cancer Study. Breast Cancer Res Treat 147(2):415–421. doi:10.1007/s10549-014-3099-z

    Article  CAS  PubMed  Google Scholar 

  15. Chan AT, Manson JE, Feskanich D, Stampfer MJ, Colditz GA, Fuchs CS (2007) Long-term aspirin use and mortality in women. Arch Intern Med 167(6):562–572

    Article  PubMed  Google Scholar 

  16. Holmes MD, Chen WY, Schnitt SJ, Collins L, Colditz GA, Hankinson SE, Tamimi RM (2011) COX-2 expression predicts worse breast cancer prognosis and does not modify the association with aspirin. Breast Cancer Res Treat 130(2):657–662. doi:10.1007/s10549-011-1651-7

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Holmes MD, Hankinson SE, Feskanich D, Chen WY (2013) Beta blockers and angiotensin-converting enzyme inhibitors’ purported benefit on breast cancer survival may be explained by aspirin use. Breast Cancer Res Treat 139(2):507–513. doi:10.1007/s10549-013-2553-7

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Barron TI, Sharp L, Bennett K, Visvanathan K (2012) Aspirin use and mortality in women with stage I–III breast cancer: A population-based study. J Clin Oncol 30(suppl;abstr 521). http://meetinglibrary.asco.org/content/99184-114

  19. Fraser D, Sullivan F, McCowan C (2013) Relationship between aspirin use after diagnosis of breast cancer and survival in a cohort of Scottish women. Eur J Surg Oncol 39(5):522

    Article  Google Scholar 

  20. Jonsson F, Yin L, Lundholm C, Smedby KE, Czene K, Pawitan Y (2013) Low-dose aspirin use and cancer characteristics: a population-based cohort study. Br J Cancer 109(7):1921–1925. doi:10.1038/bjc.2013.411

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Schapira DV, Theodossiou C, Lyman GH (1999) The effects of NSAIDs on breast cancer prognostic factors. Oncol Rep 6(2):433–435

    CAS  PubMed  Google Scholar 

  22. Chae Y, Hong DS, Kim KH, Falchook GS, Piha-Paul SA, Subbiah V, Zinner RG, Kurzrock R, Wolff RA, Janku F (2013) PIK3CA mutations, aspirin use and mortality in patients with women’s cancers or colorectal cancers treated in early-phase clinical trials. Eur J Cancer 49:S313–S314

    Google Scholar 

  23. Higgins MJ, Chapman JAW, Ingle JN, Sledge G, Budd GT, Ellis MJ, Pritchard KI, Clemons M, Badovinac CT, Han L, Gelmon K, Rabaglio M, Elliott C, Shepherd LE, Goss PE (2012) Effect of aspirin (ASP) or celecoxib (CC) use on outcomes in postmenopausal breast cancer patients randomized to adjuvant exemestane or anastrozole: nCIC CTG MA. 27. Cancer Res 72(24):2–13

    Google Scholar 

  24. Bond S (2010) Aspirin use is associated with decreased risk of breast cancer recurrence and death. J midwifery women’s health 55(4):389–390. doi:10.1016/j.jmwh.2010.04.002

    Article  Google Scholar 

  25. Thun MJ, Namboodiri MM, Calle EE, Flanders WD, Heath CW (1993) Aspirin use and risk of fatal cancer. Cancer Res 53(6):1322–1327

    CAS  PubMed  Google Scholar 

  26. Ratnasinghe LD, Graubard BI, Kahle L, Tangrea JA, Taylor PR, Hawk E (2004) Aspirin use and mortality from cancer in a prospective cohort study. Anticancer Res 24(5b):3177–3184

    PubMed  Google Scholar 

  27. Wernli KJ, Hampton JM, Trentham-Dietz A, Newcomb PA (2011) Use of antidepressants and NSAIDs in relation to mortality in long-term breast cancer survivors. Pharmacoepidemiol Drug Saf 20(2):131–137. doi:10.1002/pds.2064

    Article  PubMed Central  PubMed  Google Scholar 

  28. Li Y, Brasky TM, Nie J, Ambrosone CB, McCann SE, Shields PG, Trevisan M, Edge SB, Freudenheim JL (2012) Use of nonsteroidal anti-inflammatory drugs and survival following breast cancer diagnosis. Cancer Epidemiol Biomarkers Prev 21(1):239–242. doi:10.1158/1055-9965.epi-11-1012

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Barron TI, Flahavan EM, Sharp L, Bennett K, Visvanathan K (2014) Recent prediagnostic aspirin use, lymph node involvement, and 5-Year mortality in women with stage I–III breast cancer: a nationwide population-based cohort study. Cancer Res 74(15):4065–4077. doi:10.1158/0008-5472.can-13-2679

    Article  CAS  PubMed  Google Scholar 

  30. Murray LJ, Cooper JA, Hughes CM, Powe DG, Cardwell CR (2014) Post-diagnostic prescriptions for low-dose aspirin and breast cancer-specific survival: a nested case-control study in a breast cancer cohort from the UK Clinical Practice Research Datalink. Breast Cancer Res 16(2):R34. doi:10.1186/bcr3638

    Article  PubMed Central  PubMed  Google Scholar 

  31. Jacobo-Herrera NJ, Perez-Plasencia C, Camacho-Zavala E, Gonzalez GF, Urrutia EL, Garcia-Castillo V, Zentella-Dehesa A (2014) Clinical evidence of the relationship between aspirin and breast cancer risk (review). Oncol Rep 32(2):451. doi:10.3892/or.2014.3270

    PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the National Natural Science Foundation of China (81272470).

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jianhua Zhao.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (XLS 24 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhong, S., Zhang, X., Chen, L. et al. Association between aspirin use and mortality in breast cancer patients: a meta-analysis of observational studies. Breast Cancer Res Treat 150, 199–207 (2015). https://doi.org/10.1007/s10549-015-3300-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-015-3300-z

Keywords

Navigation