MedicalResearch.com Interview with:
Theodore Brasky, PhD
The Ohio State University
Comprehensive Cancer Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is a significant amount of data to suggest that long-term, regular use of nonsteroidal anti-inflammatory drugs (NSAIDS; examples include aspirin and ibuprofen) are associated with reduced risks of several cancers. Although the data across studies are inconsistent, one such candidate is endometrial cancer, which is the most common gynecologic cancer. There is good evidence that the use of these medications is associated with improved prognosis among patients diagnosed with colon cancer. Despite the importance of inflammation in endometrial cancer progression, very few have examined whether use of NSAIDs is associated with risk of death or recurrence from the disease. The study we published is the first of its kind to examine NSAID use comprehensively and in a study of over 4,000 patients.
MedicalResearch.com: What should readers take away from your report?
Response: We hypothesized that use of NSAIDs would be associated with reduced cancer-specific mortality (meaning, death from patients’ cancer) and recurrence. Our findings were contrary to that hypothesis. Instead of benefit, we observed that NSAID use was associated with 65%-100% increased risk of cancer-specific death. The finding was particularly strong for “Type I” endometrioid tumors, which are typically less aggressive.
It’s critically important for readers to understand several things:
1) little research has been done in this area, and so there is little context for us to place these findings;
2) the study is observational and not a clinical trial. As such, we certainly cannot say definitively that NSAIDs caused the result, but the finding adds evidence for future study;
3) importantly, we do not have a clear biologic reason why NSAIDs might cause harm in this way.
Not having a clear hypothesis for how our result could manifest biologically means that we need to be very cautious in thinking about whether the finding is real or not. That said, science is a process, and our finding is a component of that process.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We would like to further understand the role of NSAIDs on inflammation and other processes in the uterus.
MedicalResearch.com: Is there anything else you would like to add?
Response: We believe that these data are important for the progression of science, but we do not recommend that patients change their behaviors based on this, or indeed any, single study. NSAIDs are often prescribed for heart disease prevention. Given that women diagnosed with endometrial cancer are much more likely to die from heart disease than from their cancers, we wouldn’t suggest women stop their NSAID use. Patients should direct any concerns to their physicians.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Theodore M. Brasky, Ashley S. Felix, David E. Cohn, D. Scott McMeekin, David G. Mutch, William T. Creasman, Premal H. Thaker, Joan L. Walker, Richard G. Moore, Shashikant B. Lele, Saketh R. Guntupalli, Levi S. Downs, Christa I. Nagel, John F. Boggess, Michael L. Pearl, Olga B. Ioffe, Kay J. Park, Shamshad Ali, Louise A. Brinton. Nonsteroidal Anti-inflammatory Drugs and Endometrial Carcinoma Mortality and Recurrence. Journal of the National Cancer Institute, 2016; 109 (3): djw251 DOI: 10.1093/jnci/djw251
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