Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce mortality in patients with cancer, especially breast cancer, but their influence on second cancer risk is uncertain. This study aimed to examine whether NSAID use is associated with second cancer risk in patients with breast cancer. This population-based propensity score-matched cohort study using Taiwan’s National Health Insurance Research Database enrolled patients with newly diagnosed breast cancer (n = 7356) with and without (n = 1839) NSAID therapy from 2000 to 2009. They were followed up until the diagnosis of second cancer, death, or end of 2011. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR). The NSAID cohort had a lower incidence rate of second cancer than the non-NSAID cohort (5.57 vs. 9.19 per 1,000 person-years), with an aHR of 0.63 (95% confidence interval (CI) 0.46–0.87). When compared with the non-NSAID cohort, the second cancer incidence was lower in patients taking non-cyclooxygenase 2 inhibitors (aHR 0.67, 95% CI 0.47–0.94) and in those receiving multiple NSAIDs during follow-up (aHR 0.55, 95% CI 0.37–0.84). A dose–response relationship existed in NSAID cumulative days. The findings demonstrate that NSAID use reduces second cancer risk in a dose-dependent manner in patients with primary breast cancer.
Highlights
Breast cancer is one of the rapidly growing cancers in developed countries
When compared with the nonNSAID cohort, the second cancer incidence was significantly lower in patients taking non-COX-2 inhibitors and in those receiving multiple Nonsteroidal anti-inflammatory drugs (NSAIDs) during follow-up
Higher cumulative days of NSAID use was associated with a lower incidence of second cancer in a dose–response manner (p for trend 0.001), and the adjusted subdistribution HR (SHR) was 0.43 in patients using NSAID for >90 days
Summary
Breast cancer is one of the rapidly growing cancers in developed countries. In addition to resection surgery, patients with breast cancer usually receive adjuvant chemotherapy, radiotherapy, and hormone therapy after surgery. Chemotherapeutic drugs, hormone-based drugs, and radiation contribute to the long-term survival benefit of patients with breast cancer. These treatments have some inevitable long-term side effects, especially the increased risk of second cancer development [3]. With the increase in the long-term survival of patients with breast cancer, the problem of second cancer should be focused on during the follow-up of longterm survivors
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