Abstract
BackgroundResults from previous studies indicate that use of low-dose aspirin may improve breast cancer prognosis. We evaluated aspirin use and breast cancer outcomes in relation to clinical characteristics as well as dose and duration of aspirin use.MethodsWe used information from the Regional Breast Cancer Quality-of-Care Registries in three Swedish regions to identify 21,414 women diagnosed with a first stage I–III breast cancer between 1 April 2006 and 31 December 2012. The cohort was further linked to nationwide registers to retrieve information about dispensing low-dose aspirin before and after breast cancer diagnosis, comorbidity and causes of death. In a separate analysis, we investigated time to breast cancer death among 621 women with stage IV disease at diagnosis. Associations were evaluated using a multivariable Cox proportional hazards model.ResultsAmong women with stage I–III breast cancer, 2660 (12.4%) used low-dose aspirin shortly before breast cancer diagnosis and 4091 (19.1%) were users during follow-up. Women were followed for a median of 3.8 years after diagnosis. There was no association between aspirin use and breast cancer-specific death in multivariable analyses (use before diagnosis: hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.77–1.12; use after diagnosis: HR 1.00, 95% CI 0.74–1.37). Similarly, aspirin use was not associated with risk of first recurrence/metastases in a subgroup of stage I–III breast cancer patients (HR 0.97, 95% CI 0.86–1.10). However, in analyses stratified by stage, an inverse association between low-dose aspirin use after diagnosis and breast cancer death was found for women with stage I tumors (HR 0.53, 95% CI 0.29–0.96). Among women with stage IV disease at diagnosis, aspirin use was not associated with time to breast cancer death (HR 0.91, 95% CI 0.67–1.23).ConclusionIn this large population-based cohort study there was no evidence that low-dose aspirin use before or after breast cancer diagnosis is associated with a reduced risk of adverse outcomes overall in breast cancer. However, a potential benefit was noted among women with stage I tumors, warranting further investigation.
Highlights
Results from previous studies indicate that use of low-dose aspirin may improve breast cancer prognosis
The study population was identified through three regional breast cancer quality-of-care registers linked with nationwide health-care registers under the acronym BcBaSe Sweden and included all women diagnosed with a primary invasive breast cancer during the period 1 April 2006–31 December 2012
Aspirin users were older at diagnosis, and more often diagnosed with stage II–III than stage I tumors compared with nonusers (Additional file 1: Table S2)
Summary
Results from previous studies indicate that use of low-dose aspirin may improve breast cancer prognosis. Several studies have indicated that low-dose aspirin use around the time of a breast cancer diagnosis may reduce the risk of both breast cancer-specific and all-cause mortality [6,7,8,9], but results are inconsistent. A few studies have reported no associations between aspirin use after breast cancer diagnosis and breast cancer deaths [10, 11]. In a recent meta-analysis, pooled results found evidence of a reduction in breast cancer-specific death following aspirin use versus no use: RR of 0.73 (95% CI, 0.54–0.98, p = 0.04) [12]. There was heterogeneity among the included studies and following exclusion of one deviant study, the significant association between postdiagnostic aspirin use and breast cancer-specific mortality disappeared
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