Breast Cancer Research and Treatment

, Volume 150, Issue 1, pp 199–207 | Cite as

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

  • Shanliang Zhong
  • Xiaohui Zhang
  • Lin Chen
  • Tengfei Ma
  • Jinhai Tang
  • Jianhua ZhaoEmail author


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.


Aspirin Breast Cancer Prognosis Survival Outcome 



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

Conflict of interest

The authors declare no conflict of interest.

Supplementary material

10549_2015_3300_MOESM1_ESM.xls (24 kb)
Supplementary material 1 (XLS 24 kb)


  1. 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 CrossRefPubMedGoogle Scholar
  2. 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 CrossRefPubMedGoogle Scholar
  3. 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 CrossRefPubMedCentralPubMedGoogle Scholar
  4. 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 CrossRefPubMedGoogle Scholar
  5. 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 CrossRefPubMedGoogle Scholar
  6. 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. 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.
  8. 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 CrossRefPubMedGoogle Scholar
  9. 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 CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. doi: 10.1002/sim.1186 CrossRefPubMedGoogle Scholar
  11. 11.
    Hedges LV, Pigott TD (2001) The power of statistical tests in meta-analysis. Psychol Methods 6(3):203–217CrossRefPubMedGoogle Scholar
  12. 12.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634CrossRefPubMedCentralPubMedGoogle Scholar
  13. 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 CrossRefPubMedGoogle Scholar
  14. 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 CrossRefPubMedGoogle Scholar
  15. 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):562–572CrossRefPubMedGoogle Scholar
  16. 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 CrossRefPubMedCentralPubMedGoogle Scholar
  17. 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 CrossRefPubMedCentralPubMedGoogle Scholar
  18. 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).
  19. 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):522CrossRefGoogle Scholar
  20. 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 CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Schapira DV, Theodossiou C, Lyman GH (1999) The effects of NSAIDs on breast cancer prognostic factors. Oncol Rep 6(2):433–435PubMedGoogle Scholar
  22. 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–S314Google Scholar
  23. 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):2–13Google Scholar
  24. 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 CrossRefGoogle Scholar
  25. 25.
    Thun MJ, Namboodiri MM, Calle EE, Flanders WD, Heath CW (1993) Aspirin use and risk of fatal cancer. Cancer Res 53(6):1322–1327PubMedGoogle Scholar
  26. 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):3177–3184PubMedGoogle Scholar
  27. 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 CrossRefPubMedCentralPubMedGoogle Scholar
  28. 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 CrossRefPubMedCentralPubMedGoogle Scholar
  29. 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 CrossRefPubMedGoogle Scholar
  30. 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 CrossRefPubMedCentralPubMedGoogle Scholar
  31. 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 PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Shanliang Zhong
    • 1
  • Xiaohui Zhang
    • 1
  • Lin Chen
    • 2
  • Tengfei Ma
    • 1
  • Jinhai Tang
    • 3
  • Jianhua Zhao
    • 1
    Email author
  1. 1.Center of Clinical Laboratory ScienceJiangsu Cancer Hospital Affiliated to Nanjing Medical UniversityNanjingChina
  2. 2.Department of OncologyXuzhou Medical CollegeXuzhouChina
  3. 3.Department of General SurgeryJiangsu Cancer Hospital Affiliated to Nanjing Medical UniversityNanjingChina

Personalised recommendations