OA04.05 Chronic Inflammation, NSAIDS and the Risk of Lung Cancer Death

Abstract

Chronic inflammation appears to heighten the risk of lung cancer and, reciprocally, agents that reduce inflammation have been found to reduce this risk. Nevertheless, few prospective studies have examined associations between lung cancer and the intake of nonsteroidal anti-inflammatory drugs (NSAIDs). In the current study, we examined associations between fatal lung cancer and NSAIDs using prospective data from the Third National Health and Nutrition Examination Study. Baseline data on smoking, NSAIDs and other lifestyle variables were collected for 10,735 participants during 1988-1994, and cause-specific mortality status was ascertained through probabilistic record matching using the National Death Index through 2006. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) to quantify associations between NSAID use and lung cancer death, with adjustment for current smoking and other variables. During 18 years of follow-up, 269 individuals died from lung cancer of which 252 (93.6%) reported a history of cigarette smoking. Since all but 17 of the 269 fatal lung cancer cases occurred among current or former smokers, estimates of NSAID effects were ascertained from a sub-cohort of 5,882 individuals who reported a history of past or current cigarette smoking. Multivariate regression models revealed that regular use of ibuprofen reduced the risk of lung cancer death by 48% (HR=0.52, 95% CI=0.33-0.82, P<0.01). Main effects of other compounds tested (aspirin or acetaminophen) were not statistically significant. Prospective data from NHANES III showed that among adults with a history of past or current smoking, ibuprofen intake was associated with a substantial (48%) reduction in the risk of dying from lung cancer. Effects of aspirin and acetaminophen were not statistically significant. These results suggest that regular use of certain NSAIDs may be beneficial for high-risk subgroups of smokers as a lung cancer prevention strategy.