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