Abstract
Introduction: Research has demonstrated that use of non‐steroidal anti‐inflammatory drugs (NSAIDs) decreases the risk of developing colorectal cancer as well as the recurrence of the disease among those with prior colorectal cancer. Limited prior studies investigating the association with colorectal cancer (CRC) survival have also observed a beneficial effect of NSAID use, specifically aspirin, against colorectal cancer mortality. We examined the role of pre‐diagnostic aspirin and non‐aspirin NSAID use on colorectal cancer‐specific mortality in a population‐based study.
Methods: We investigated the effect of NSAID use on CRC mortality after diagnosis among 1,737 incident colorectal cancer cases identified from the Seattle Colon Cancer Family Registry. Type of medication, duration, and timing of use relative to diagnosis were collected for NSAIDs, including aspirin and ibuprofen. Cases were followed up for mortality through linkages to the National Death Index records to obtain date and cause of death. Cox proportional hazards regression models were used to assess the relationship between pre‐diagnostic NSAID use and colorectal cancer‐specific mortality and to estimate hazard ratios and 95% confidence intervals.
Results: Regular, pre‐diagnostic use of NSAID medications was associated with a 21% decrease in CRC mortality (HR: 0.79; 95% CI 0.65–0.97); current use was associated with a 25% decreased risk of CRC mortality (HR: 0.75; 95% CI 0.58–0.96); former use was not associated with a significant survival benefit. Among cases with advanced disease, regular use of NSAID medications was not observed to significantly alter CRC mortality. However, regular and current pre‐diagnostic use of NSAID medications was associated with a 31% and 37% decrease, respectively, in CRC mortality (95% CI: 0.53– 0.90; 0.46–0.87) among cases with non‐advanced disease. Although cases with distal and rectal tumors did not experience a survival benefit from NSAID use, regular pre‐diagnostic NSAID use was associated with a 32% decreased risk of CRC mortality among cases with proximal tumors (HR: 0.68; 95% CI 0.51–0.92).
Conclusion: Our results demonstrate that regular pre‐diagnostic use of NSAIDs, including aspirin, is associated with improved colorectal cancer survival, particularly if the medications are taken recently prior to diagnosis. This improvement in survival may be mediated through alteration in disease progression, resulting in lower stage of disease at presentation, among those with regular NSAID use. The survival benefit was not explained by increased screening among NSAID users, and the improvement appears to be particularly strong among patients diagnosed with proximal tumors and with non‐advanced disease.
Citation Information: Cancer Prev Res 2010;3(1 Suppl):A134.
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