Aspirin and risk for gastric cancer: a population-based case–control study in Sweden (original) (raw)

Abstract

While aspirin and other non-steroid anti-inflammatory drugs (NSAIDs) are associated with gastric mucosal damage, they might reduce the risk for gastric cancer. In a population-based case–control study in 5 Swedish counties, we interviewed 567 incident cases of gastric cancer and 1165 controls about their use of pain relievers. The cases were uniformly classified to subsite (cardia/non-cardia) and histological type and information collected on other known risk factors for gastric cancer. Helicobacter pylori serology was tested in a subset of 542 individuals. Users of aspirin had a moderately reduced risk of gastric cancer compared to never users; odds ratio (OR) adjusted for age, gender and socioeconomic status was 0.7 (95% CI = 0.6–1.0). Gastric cancer risk fell with increasing frequency of aspirin use (P for trend = 0.02). The risk reduction was apparent for both cardia and non-cardia tumours but was uncertain for the diffuse histologic type. No clear association was observed between gastric cancer risk and non-aspirin NSAIDs or other studied pain relievers. Our finding lends support to the hypothesis that use of aspirin reduces the risk for gastric cancer. © 2001 Cancer Research Campaign http://www.bjcancer.com

Keywords: gastric cancer, aspirin, NSAIDs, Helicobacter pylori

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Selected References

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  1. Ekström A. M., Eriksson M., Hansson L. E., Lindgren A., Signorello L. B., Nyrén O., Hardell L. Occupational exposures and risk of gastric cancer in a population-based case-control study. Cancer Res. 1999 Dec 1;59(23):5932–5937. [PubMed] [Google Scholar]
  2. Ekström A. M., Serafini M., Nyrén O., Hansson L. E., Ye W., Wolk A. Dietary antioxidant intake and the risk of cardia cancer and noncardia cancer of the intestinal and diffuse types: a population-based case-control study in Sweden. Int J Cancer. 2000 Jul 1;87(1):133–140. [PubMed] [Google Scholar]
  3. Ekström A. M., Signorello L. B., Hansson L. E., Bergström R., Lindgren A., Nyrén O. Evaluating gastric cancer misclassification: a potential explanation for the rise in cardia cancer incidence. J Natl Cancer Inst. 1999 May 5;91(9):786–790. doi: 10.1093/jnci/91.9.786. [DOI] [PubMed] [Google Scholar]
  4. Farrow D. C., Vaughan T. L., Hansten P. D., Stanford J. L., Risch H. A., Gammon M. D., Chow W. H., Dubrow R., Ahsan H., Mayne S. T. Use of aspirin and other nonsteroidal anti-inflammatory drugs and risk of esophageal and gastric cancer. Cancer Epidemiol Biomarkers Prev. 1998 Feb;7(2):97–102. [PubMed] [Google Scholar]
  5. Giardiello F. M., Hamilton S. R., Krush A. J., Piantadosi S., Hylind L. M., Celano P., Booker S. V., Robinson C. R., Offerhaus G. J. Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis. N Engl J Med. 1993 May 6;328(18):1313–1316. doi: 10.1056/NEJM199305063281805. [DOI] [PubMed] [Google Scholar]
  6. Gridley G., McLaughlin J. K., Ekbom A., Klareskog L., Adami H. O., Hacker D. G., Hoover R., Fraumeni J. F., Jr Incidence of cancer among patients with rheumatoid arthritis. J Natl Cancer Inst. 1993 Feb 17;85(4):307–311. doi: 10.1093/jnci/85.4.307. [DOI] [PubMed] [Google Scholar]
  7. Hansson L. E., Baron J., Nyrén O., Bergström R., Wolk A., Lindgren A., Adami H. O. Early-life risk indicators of gastric cancer. A population-based case-control study in Sweden. Int J Cancer. 1994 Apr 1;57(1):32–37. doi: 10.1002/ijc.2910570107. [DOI] [PubMed] [Google Scholar]
  8. Hawkey C. J. Non-steroidal anti-inflammatory drug gastropathy: causes and treatment. Scand J Gastroenterol Suppl. 1996;220:124–127. doi: 10.3109/00365529609094763. [DOI] [PubMed] [Google Scholar]
  9. Isomäki H. A., Hakulinen T., Joutsenlahti U. Excess risk of lymphomas, leukemia and myeloma in patients with rheumatoid arthritis. J Chronic Dis. 1978;31(11):691–696. doi: 10.1016/0021-9681(78)90071-1. [DOI] [PubMed] [Google Scholar]
  10. Jones M. K., Wang H., Peskar B. M., Levin E., Itani R. M., Sarfeh I. J., Tarnawski A. S. Inhibition of angiogenesis by nonsteroidal anti-inflammatory drugs: insight into mechanisms and implications for cancer growth and ulcer healing. Nat Med. 1999 Dec;5(12):1418–1423. doi: 10.1038/70995. [DOI] [PubMed] [Google Scholar]
  11. Kune G. A., Kune S., Watson L. F. Colorectal cancer risk, chronic illnesses, operations, and medications: case control results from the Melbourne Colorectal Cancer Study. Cancer Res. 1988 Aug 1;48(15):4399–4404. [PubMed] [Google Scholar]
  12. LAUREN P. THE TWO HISTOLOGICAL MAIN TYPES OF GASTRIC CARCINOMA: DIFFUSE AND SO-CALLED INTESTINAL-TYPE CARCINOMA. AN ATTEMPT AT A HISTO-CLINICAL CLASSIFICATION. Acta Pathol Microbiol Scand. 1965;64:31–49. doi: 10.1111/apm.1965.64.1.31. [DOI] [PubMed] [Google Scholar]
  13. Lupulescu A. Prostaglandins, their inhibitors and cancer. Prostaglandins Leukot Essent Fatty Acids. 1996 Feb;54(2):83–94. doi: 10.1016/s0952-3278(96)90064-2. [DOI] [PubMed] [Google Scholar]
  14. Marchildon P. A., Ciota L. M., Zamaniyan F. Z., Peacock J. S., Graham D. Y. Evaluation of three commercial enzyme immunoassays compared with the 13C urea breath test for detection of Helicobacter pylori infection. J Clin Microbiol. 1996 May;34(5):1147–1152. doi: 10.1128/jcm.34.5.1147-1152.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Marnett L. J. Aspirin and the potential role of prostaglandins in colon cancer. Cancer Res. 1992 Oct 15;52(20):5575–5589. [PubMed] [Google Scholar]
  16. Misumi A., Murakami A., Harada K., Baba K., Akagi M. Definition of carcinoma of the gastric cardia. Langenbecks Arch Chir. 1989;374(4):221–226. doi: 10.1007/BF01359557. [DOI] [PubMed] [Google Scholar]
  17. Morales T. G. Adenocarcinoma of the gastric cardia. Dig Dis. 1997 Nov-Dec;15(6):346–356. doi: 10.1159/000171610. [DOI] [PubMed] [Google Scholar]
  18. Rosenberg L., Palmer J. R., Zauber A. G., Warshauer M. E., Stolley P. D., Shapiro S. A hypothesis: nonsteroidal anti-inflammatory drugs reduce the incidence of large-bowel cancer. J Natl Cancer Inst. 1991 Mar 6;83(5):355–358. doi: 10.1093/jnci/83.5.355. [DOI] [PubMed] [Google Scholar]
  19. Sawaoka H., Kawano S., Tsuji S., Tsuji M., Sun W., Gunawan E. S., Hori M. Helicobacter pylori infection induces cyclooxygenase-2 expression in human gastric mucosa. Prostaglandins Leukot Essent Fatty Acids. 1998 Nov;59(5):313–316. doi: 10.1016/s0952-3278(98)90079-5. [DOI] [PubMed] [Google Scholar]
  20. Sawaoka H., Kawano S., Tsuji S., Tsujii M., Gunawan E. S., Takei Y., Nagano K., Hori M. Cyclooxygenase-2 inhibitors suppress the growth of gastric cancer xenografts via induction of apoptosis in nude mice. Am J Physiol. 1998 Jun;274(6 Pt 1):G1061–G1067. doi: 10.1152/ajpgi.1998.274.6.G1061. [DOI] [PubMed] [Google Scholar]
  21. Sawaoka H., Kawano S., Tsuji S., Tsujii M., Murata H., Hori M. Effects of NSAIDs on proliferation of gastric cancer cells in vitro: possible implication of cyclooxygenase-2 in cancer development. J Clin Gastroenterol. 1998;27 (Suppl 1):S47–S52. doi: 10.1097/00004836-199800001-00009. [DOI] [PubMed] [Google Scholar]
  22. Schreinemachers D. M., Everson R. B. Aspirin use and lung, colon, and breast cancer incidence in a prospective study. Epidemiology. 1994 Mar;5(2):138–146. doi: 10.1097/00001648-199403000-00003. [DOI] [PubMed] [Google Scholar]
  23. Shiff S. J., Rigas B. Nonsteroidal anti-inflammatory drugs and colorectal cancer: evolving concepts of their chemopreventive actions. Gastroenterology. 1997 Dec;113(6):1992–1998. doi: 10.1016/s0016-5085(97)99999-6. [DOI] [PubMed] [Google Scholar]
  24. Thun M. J., Namboodiri M. M., Calle E. E., Flanders W. D., Heath C. W., Jr Aspirin use and risk of fatal cancer. Cancer Res. 1993 Mar 15;53(6):1322–1327. [PubMed] [Google Scholar]
  25. Tsuji S., Kawano S., Sawaoka H., Takei Y., Kobayashi I., Nagano K., Fusamoto H., Kamada T. Evidences for involvement of cyclooxygenase-2 in proliferation of two gastrointestinal cancer cell lines. Prostaglandins Leukot Essent Fatty Acids. 1996 Sep;55(3):179–183. doi: 10.1016/s0952-3278(96)90095-2. [DOI] [PubMed] [Google Scholar]
  26. Zaridze D., Borisova E., Maximovitch D., Chkhikvadze V. Aspirin protects against gastric cancer: results of a case-control study from Moscow, Russia. Int J Cancer. 1999 Aug 12;82(4):473–476. doi: 10.1002/(sici)1097-0215(19990812)82:4<473::aid-ijc1>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]