BACKGROUND AND PURPOSE: 

• Case-control studies have demonstrated an association between low-dose aspirin and decreased risk for ovarian cancer  
  • Increased risk (19% higher) has been identified with use of nonaspirin NSAIDs  
• Barnard et al. (JAMA Oncology, 2018) assessed whether long term use of regular aspirin or nonaspirin NSAIDs reduce risk ovarian cancer

METHODS: 

• Prospective Cohort study  
• NSAID use and ovarian cancer diagnosis data from 2 prospective cohorts 
  • Nurses’ Health Study (NHS)  
  • Nurses’ Health Study II (NHSII) 
• Data collected for each analgesic type (aspirin, low-dose aspirin, nonaspirin NSAIDs, and acetaminophen) 
  • Timing, duration, frequency, and number of tablets used 
  • Exposure information (updated every 2 to 4 years) 
• Primary outcome: Hazard ratios (HRs) for association between analgesic type with risk of epithelial ovarian cancer

RESULTS: 

• NHS study  
  • 93,664 women  
  • Mean age at baseline: 45.9 years 
  • 93% of participants were non-Hispanic white 
• NHSII study  
  • 111,834 women  
  • Mean age at baseline: 34.2 years 
  • 92% were non-Hispanic white 
• Total 205,498 women | 1054 cases of incident epithelial ovarian cancer 
• Significant associations between aspirin and ovarian cancer risk were not observed when current vs nonuse of any aspirin was evaluated regardless of dose  
  • Hazard ratio (HR) 0.99; 95% CI, 0.83-1.19 
• Low-dose (≤100-mg) aspirin was associated with an inverse relationship for ovarian cancer  
  • HR 0.77; 95% CI, 0.61-0.96 
  • No association for standard-dose aspirin was observed 
• Current use of nonaspirin NSAIDs was positively associated with ovarian cancer risk compared with nonuse  
  • HR 1.19; 95% CI, 1.00-1.41 
• In addition, the following was associated with increased risk  
  • Duration of use ≥10 years (P = .02 for trend)  
  • Cumulative average tablets per week of ≥10 vs <1 (P = .03 for trend)  
  • 2,500 or more tablet-days (P = .006 for trend)

CONCLUSION: 

• Low-dose aspirin was associated with decreased risk for ovarian cancer 
• Recommendations advising adults aged 50 to 59 years with a 10-year risk of cardiovascular disease greater than 10% to initiate low-dose aspirin therapy is unlikely to increase the risk of ovarian cancer  
• Nonaspirin NSAIDs were not associated with reduced risk for ovarian cancer and heavier use and duration may be associated with an increased risk for ovarian cancer

Learn More – Primary Sources: 

Association of Analgesic Use With Risk of Ovarian Cancer in the Nurses’ Health Studies

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