频繁使用非甾体抗炎药与乳腺癌之间的关联。
Association between frequent use of nonsteroidal anti-inflammatory drugs and breast cancer.
作者信息
Rahme Elham, Ghosn Joumana, Dasgupta Kaberi, Rajan Raghu, Hudson Marie
机构信息
Division of Clinical Epidemiology, McGill University Health Centre Research Institute, Montreal, Canada.
出版信息
BMC Cancer. 2005 Dec 12;5:159. doi: 10.1186/1471-2407-5-159.
BACKGROUND
Eighty percent of all breast cancers and almost 90% of breast cancer deaths occur among post-menopausal women. We used a nested case control design to examine the association between nonsteroidal anti-inflammatory drug (NSAID) use and breast cancer occurrence among women over 65 years of age. The cyclooxygenase (COX)-2 enzyme is expressed more in breast cancers than in normal breast tissue. COX-2 inhibition may have a role in breast cancer prevention.
METHODS
In the Canadian province of Quebec, physician services are covered through a governmental insurance plan. Medication costs are covered for those > or = 65 years of age and a publicly funded screening program for breast cancer targets all women 50 years of age or older. We obtained encrypted data from these insurance databases on all women > or = 65 years of age who filled a prescription for COX-2 inhibitors, non-selective NSAIDs (ns-NSAIDs), aspirin, or acetaminophen between January 1998 and December 2002. Cases were defined as those women who have undergone mammography between April 2001 and June 2002 and had a diagnosis of breast cancer within six months following mammography. Controls included those who have undergone mammography between April 2001 and June 2002 without a diagnosis of any cancer during the six months following mammography. The exposure of interest, frequent NSAID use, was defined as use of ns-NSAIDs and/or COX-2 inhibitors for > or = 90 days during the year prior to mammography. Frequent use served as a convenient proxy for long term chronic use.
RESULTS
We identified 1,090 cases and 44,990 controls. Cases were older and more likely to have breast cancer risk factors. Logistic regression models adjusting for potential confounders showed that frequent use of ns-NSAIDs and/or COX-2 inhibitors was associated with a lower risk of breast cancer (OR: 0.75, 95% confidence interval 0.64-0.89). Results were similar for COX-2 inhibitors (0.81, 0.68-0.97) and ns-NSAIDs (0.65, 0.43-0.99), when assessed separately. Frequent use of aspirin at doses > 100 mg/day in the year prior to mammography was also associated with a lower risk of breast cancer (0.75, 0.64-0.89). However, use of aspirin at doses < or = 100 mg/day did not have any association with breast cancer (0.91, 0.71-1.16).
CONCLUSION
Women who use NSAIDs or doses of aspirin > 100 mg frequently may have a lower risk of breast cancer.
背景
所有乳腺癌患者中的80%以及几乎90%的乳腺癌死亡病例发生在绝经后女性中。我们采用巢式病例对照设计，研究65岁以上女性使用非甾体抗炎药（NSAID）与乳腺癌发生之间的关联。环氧化酶（COX）-2酶在乳腺癌中的表达高于正常乳腺组织。COX-2抑制可能在乳腺癌预防中发挥作用。
方法
在加拿大魁北克省，医师服务通过政府保险计划覆盖。65岁及以上人群的药物费用可报销，且一项由公共资金支持的乳腺癌筛查项目针对所有50岁及以上女性。我们从这些保险数据库中获取了1998年1月至2002年12月期间所有65岁及以上且开具过COX-2抑制剂、非选择性NSAIDs（ns-NSAIDs）、阿司匹林或对乙酰氨基酚处方的女性的加密数据。病例定义为那些在2001年4月至2002年6月期间接受过乳房X线摄影检查且在乳房X线摄影检查后六个月内被诊断为乳腺癌的女性。对照包括那些在2001年4月至2002年6月期间接受过乳房X线摄影检查且在乳房X线摄影检查后六个月内未被诊断出任何癌症的女性。感兴趣的暴露因素，即频繁使用NSAID，定义为在乳房X线摄影检查前一年中使用ns-NSAIDs和/或COX-2抑制剂≥90天。频繁使用作为长期慢性使用的一个便捷替代指标。
结果
我们确定了1090例病例和44990例对照。病例年龄更大，更有可能具有乳腺癌危险因素。对潜在混杂因素进行调整的逻辑回归模型显示，频繁使用ns-NSAIDs和/或COX-2抑制剂与较低的乳腺癌风险相关（比值比：0.75，95%置信区间0.64 - 0.89）。单独评估时，COX-2抑制剂（0.81，0.68 - 0.97）和ns-NSAIDs（0.65，0.43 - 0.99）的结果相似。在乳房X线摄影检查前一年中频繁使用剂量>100mg/天的阿司匹林也与较低的乳腺癌风险相关（0.75，0.64 - 0.89）。然而，使用剂量≤100mg/天的阿司匹林与乳腺癌无任何关联（0.91，0.71 - 1.16）。
结论
频繁使用NSAIDs或剂量>100mg的阿司匹林的女性可能患乳腺癌的风险较低。
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