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Aspirin and nonsteroidal anti-inflammatory drugs after but not before diagnosis are associated with improved breast cancer survival: a meta-analysis

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Abstract

Purpose

The association between nonsteroidal anti-inflammatory drugs (NSAIDs) and breast cancer survival is still controversial. The aim of our meta-analysis was to assess the survival benefit of NSAIDs.

Methods

A literature search was conducted in PubMed and EMBASE (to September 2014). A meta-analysis was performed with hazard ratios (HRs) and 95 % confidence intervals (CIs) as the effect measures. Subgroup analyses were based on time of NSAID use (before and after diagnosis), medication type (aspirin and other nonaspirin NSAIDs), and study design (cohort and case–control studies).

Results

There were 16 eligible studies. Use of NSAIDs after diagnosis was significantly inversely associated with relapse/metastasis (HR 0.69, 95 % CI 0.59–0.80) and tended toward potentially protective effects on all-cause mortality, although significance was not reached (HR 0.79, 95 % CI 0.61–1.02). In cohort studies, the association between post-diagnostic use of NSAIDs and breast cancer survival was stronger with reduced heterogeneity (breast-cancer-specific mortality: HR 0.65, 95 % CI 0.48–0.89, I 2 = 65.3 %; all-cause mortality: HR 0.73, 95 % CI 0.57–0.92, I 2 = 83.2 %; relapse/metastasis: HR 0.73, 95 % CI 0.61–0.86, I 2 = 48.3 %). Aspirin use after diagnosis was significantly associated with breast-cancer-specific mortality (HR 0.69, 95 % CI 0.50–0.96) and relapse/metastasis (HR 0.75, 95 % CI 0.56–1.00), and tended toward a protective effect on all-cause mortality, although significance was not reached (HR 0.79, 95 % CI 0.60–1.03). Including cohort studies only, we obtained similar results and post-diagnostic use of aspirin was significantly associated with all-cause mortality (HR 0.72, 95 % CI 0.56–0.93).

Conclusions

NSAIDs and aspirin after but not before diagnosis were associated with improved breast cancer survival, including breast-cancer-specific mortality, all-cause mortality, and relapse/metastasis.

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Acknowledgments

We thank the department of Surgical Oncology of First Hospital of China Medical University and the College of China Medical University for technical assistance. This work was supported by National Science Foundation of China (Nos. 81201888, 81372549, and 81172370), Specialized Research Fund for the Doctoral Program of Higher Education (No. 20122104110009), and Natural Science Foundation of Liaoning Province (No. 2014029201), Program of Education Department of Liaoning Province (L2014307).

Conflict of interest

All the authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City, 110001, People’s Republic of China

    Xuan-zhang Huang, Peng Gao, Jing-xu Sun, Yong-xi Song, Cheng-che Tsai, Jing Liu, Xiao-wan Chen, Ping Chen, Hui-mian Xu & Zhen-ning Wang

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  1. Xuan-zhang Huang
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Correspondence to Zhen-ning Wang.

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Xuan-zhang Huang and Peng Gao have contributed equally to this work.

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Huang, Xz., Gao, P., Sun, Jx. et al. Aspirin and nonsteroidal anti-inflammatory drugs after but not before diagnosis are associated with improved breast cancer survival: a meta-analysis. Cancer Causes Control 26, 589–600 (2015). https://doi.org/10.1007/s10552-015-0539-y

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