Abstract
PurposeSeveral epidemiologic studies have evaluated the association between nonsteroidal anti-inflammatory drugs (NSAIDs) and bladder cancer risk and the results were varied. Thus, we conducted a comprehensive meta-analysis of studies exclusively dedicated to the relationship between the 3 most commonly used analgesics and bladder cancer risk.MethodsA systematic literature search up to November 2012 was performed in PubMed database for 3 categories of analgesics: acetaminophen, aspirin or non-aspirin NSAIDs. Study-specific risk estimates were pooled using a random-effects model.ResultsSeventeen studies (8 cohort and 9 case-control studies), involving a total of 10,618 bladder cancer cases, were contributed to the analysis. We found that acetaminophen (relative risk [RR] 1.01, 95% confidence interval [CI] 0.88–1.17) and aspirin (RR 1.02, 95% CI 0.91–1.14) were not associated with bladder cancer risk. Although non-aspirin NSAIDs was statistically significantly associated with reduced risk of bladder cancer among case-control studies (but not cohort studies), the overall risk was not statistically significant (RR 0.87, 95% CI 0.73–1.05). Furthermore, we also found that non-aspirin NSAIDs use was significantly associated with a 43% reduction in bladder cancer risk among nonsmokers (RR 0.57, 95% CI 0.43–0.76), but not among current smokers.ConclusionThe results of our meta-analysis suggest that there is no association between use of acetaminophen, aspirin or non-aspirin NSAIDs and bladder cancer risk. However, non-aspirin NSAIDs use might be associated with a reduction in risk of bladder cancer for nonsmokers.
Highlights
Bladder cancer is the most common malignant tumor of the urinary system
Two publications were excluded because there were no outcomes of bladder cancer [19,20], one was excluded because it did not provide RR estimate [21] and the remaining one was excluded because it did not report analgesics use of our interest [22]
We found that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) use was statistically significantly associated with reduced risk of bladder cancer among case-control studies, but not among cohort studies (Table 3)
Summary
Bladder cancer is the most common malignant tumor of the urinary system. The majority of bladder cancer occurs in males and the highest incidence rates are found in the countries of Europe, North America, and Northern Africa [1]. The overall public health importance of bladder cancer is increasing with the growing elderly population. Cigarette smoking and occupational exposures are the main risk factors for bladder cancer in Western countries, whereas chronic infection with Schistosoma hematobium in developing countries accounts for about 50% of the total burden [3]. Other environmental factors, including selenium intake [4], chlorination by-products [5] and low dose arsenic levels in drinking water [6], have been associated with bladder cancer, but are less wellestablished
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