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Baker A, Kartsonaki C. Aspirin Use and Survival Among Patients With Breast Cancer: A Systematic Review and Meta-Analysis. Oncologist 2024; 29:e1-e14. [PMID: 37358878 PMCID: PMC10769789 DOI: 10.1093/oncolo/oyad186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/25/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Previous meta-analyses have indicated that aspirin could affect breast cancer outcomes, particularly when taken post-diagnostically. However, several recent studies appear to show little to no association between aspirin use and breast cancer mortality, all-cause mortality, or recurrence. AIMS This study aims to conduct an updated systematic review and meta-analysis on the associations of pre-diagnostic and post-diagnostic aspirin use with the aforementioned breast cancer outcomes. It also looks, through subgroup analyses and meta-regressions, at a range of variables that could explain the associations between aspirin use and breast cancer outcomes. RESULTS In total, 24 papers and 149 860 patients with breast cancer were included. Pre-diagnostic aspirin use was not associated with breast-cancer-specific mortality (HR 0.98, 95% CI, 0.80-1.20, P = .84) or recurrence (HR 0.94, 95% CI, 0.88-1.02, P = .13). Pre-diagnostic aspirin was associated with non-significantly higher all-cause mortality (HR 1.27, 95% CI, 0.95-1.72, P = .11). Post-diagnostic aspirin was not significantly associated with all-cause mortality (HR 0.87, 95% CI, 0.71-1.07, P = .18) or recurrence (HR 0.89, 95% CI, 0.67-1.16, P = .38). Post-diagnostic aspirin use was significantly associated with lower breast-cancer-specific mortality (HR 0.79, 95% CI, 0.64-0.98, P = .032). CONCLUSIONS The only significant association of aspirin with breast cancer outcomes is lower breast-cancer-specific mortality in patients who used aspirin post-diagnostically. However, factors such as selection bias and high inter-study heterogeneity mean that this result should not be treated as conclusive, and more substantial evidence such as that provided by RCTs is needed before any decisions on new clinical uses for aspirin should be made.
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Affiliation(s)
- Adam Baker
- Department of Medical Sciences, Worcester College, University of Oxford, Oxford, UK
| | - Christiana Kartsonaki
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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2
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Wang T, McCullough LE, White AJ, Bradshaw PT, Xu X, Cho YH, Terry MB, Teitelbaum SL, Neugut AI, Santella RM, Chen J, Gammon MD. Prediagnosis aspirin use, DNA methylation, and mortality after breast cancer: A population-based study. Cancer 2019; 125:3836-3844. [PMID: 31402456 DOI: 10.1002/cncr.32364] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/20/2018] [Accepted: 01/07/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The authors hypothesized that epigenetic changes may help to clarify the underlying biologic mechanism linking aspirin use to breast cancer prognosis. To the authors' knowledge, this is the first epidemiologic study to examine whether global methylation and/or tumor promoter methylation of breast cancer-related genes interact with aspirin use to impact mortality after breast cancer. METHODS Prediagnosis aspirin use was assessed through in-person interviews within a population-based cohort of 1508 women diagnosed with a first primary breast cancer in 1996 and 1997. Global methylation in peripheral blood was assessed by long interspersed elements-1 (LINE-1) and the luminometric methylation assay. Promoter methylation of 13 breast cancer-related genes was measured in tumor by methylation-specific polymerase chain reaction and the MethyLight assay. Vital status was determined by the National Death Index through December 31, 2014 (N = 202/476 breast cancer-specific/all-cause deaths identified among 1266 women with any methylation assessment and complete aspirin data). Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs, and the likelihood ratio test was used to evaluate multiplicative interactions. RESULTS All-cause mortality was elevated among aspirin users who had methylated promotor of BRCA1 (HR, 1.67; 95% CI, 1.26-2.22), but not among those with unmethylated promoter of BRCA1 (HR, 0.99; 95% CI, 0.67-1.45; P for interaction ≤.05). Decreased breast cancer-specific mortality was observed among aspirin users who had unmethylated promotor of BRCA1 and PR and global hypermethylation of LINE-1 (HR, 0.60, 0.78, and 0.63, respectively; P for interaction ≤.05), although the 95% CIs included the null. CONCLUSIONS The current study suggests that the LINE-1 global methylation and promoter methylation of BRCA1 and PR in tumor may interact with aspirin use to influence mortality after breast cancer.
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Affiliation(s)
- Tengteng Wang
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Alexandra J White
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Patrick T Bradshaw
- Division of Epidemiology, University of California, Berkeley, California
| | - Xinran Xu
- Department of Biometrics, Roche Product Development in Asia-Pacific, Shanghai, China
| | - Yoon Hee Cho
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, Montana
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University, New York, New York
| | - Susan L Teitelbaum
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alfred I Neugut
- Department of Epidemiology, Columbia University, New York, New York.,Department of Medicine, Columbia University, New York, New York
| | | | - Jia Chen
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marilie D Gammon
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
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Leite ADM, Macedo AVS, Jorge AJL, Martins WDA. Antiplatelet Therapy in Breast Cancer Patients Using Hormonal Therapy: Myths, Evidence and Potentialities - Systematic Review. Arq Bras Cardiol 2018; 111:205-212. [PMID: 30183988 PMCID: PMC6122903 DOI: 10.5935/abc.20180138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 06/12/2018] [Indexed: 12/21/2022] Open
Abstract
Breast cancer is the most frequently diagnosed tumor in women worldwide, with a
significant impact on morbidity and mortality. Chemotherapy and hormone therapy
have significantly reduced mortality; however, the adverse effects are
significant. Aspirin has been incorporated into clinical practice for over 100
years at a low cost, making it particularly attractive as a potential agent in
breast cancer prevention and as an adjunct treatment to endocrine therapy in the
prophylaxis of cardiovascular complications. The objective of this study was to
evaluate the role of aspirin in reducing the incidence of breast cancer and to
evaluate the impact of its use on morbidity and mortality and reduction of
cardiovascular events as adjuvant therapy during breast cancer treatment with
selective estrogen receptor modulators. A systematic review was performed using
the PRISMA methodology and PICO criteria, based on the MEDLINE, EMBASE and
LILACS databases. The original articles of clinical trials, cohort, case-control
studies and meta-analyses published from January 1998 to June 2017, were
considered. Most studies showed an association between the use of selective
estrogen receptor modulators and the increase in thromboembolic events. The
studies suggest a protective effect of aspirin for cardiovascular events during
its concomitant use with selective estrogen receptor modulators and in the
prevention of breast cancer. This systematic review suggests that aspirin
therapy combines the benefit of protection against cardiovascular events with
the potential reduction in breast cancer risk, and that the evaluation of the
benefits of the interaction of endocrine therapy with aspirin should be further
investigated.
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Affiliation(s)
- Andréa de Melo Leite
- Programa de Pós-graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil.,Rede D'Or São Luiz, Rio de Janeiro, RJ - Brazil
| | | | - Antonio José Lagoeiro Jorge
- Programa de Pós-graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
| | - Wolney de Andrade Martins
- Programa de Pós-graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
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4
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The impact of aspirin use on breast cancer subtype and clinical course. J Surg Res 2018; 230:71-79. [PMID: 30100043 DOI: 10.1016/j.jss.2018.04.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/16/2018] [Accepted: 04/17/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND The use of aspirin has been associated with improved survival in patients with breast cancer, but the results have been mixed. We aim to analyze the impact of aspirin use before or after breast cancer diagnosis on breast cancer clinical characteristics and outcomes. MATERIALS AND METHODS We performed a single-institution, retrospective analysis of 1113 women diagnosed with operable breast cancer between 1995 and 2015. Patients were grouped according to their aspirin use: never (944), before diagnosis (79), and after diagnosis (90). Clinical variables, overall survival (OS), and disease-free survival (DFS) were compared between groups. RESULTS Women using aspirin before diagnosis were older, more likely to be black, and to have associated medical comorbidities than patients in other groups (all P <0.001). These patients were also more likely to present with hormone receptor-negative cancers, including triple-negative breast cancer (P = 0.002). Aspirin use before diagnosis was associated with a worse OS in univariate and multivariate analyses (both P <0.001), but there were no other differences in OS or DFS related to aspirin use. CONCLUSIONS Despite a potential impact on tumor subtype in patients using aspirin before their breast cancer diagnosis, aspirin use does not appear to alter breast cancer-related survival.
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5
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Wang T, Parada H, McClain KM, Bradshaw PT, Terry MB, Teitelbaum SL, Neugut AI, Gammon MD. Pre-diagnostic aspirin use and mortality after breast cancer. Cancer Causes Control 2018. [PMID: 29516320 DOI: 10.1007/s10552-018-1020-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Whether aspirin or other nonsteroidal anti-inflammation drug (NSAID) use is associated with mortality following breast cancer remains unclear. Consideration of use patterns and interaction with obesity may help to clarify the inconsistent results. METHODS Pre-diagnosis NSAID use, weight, and height were assessed ~ 3 months after diagnosis through in-person interviews with a population-based cohort of 1,442 women with first primary breast cancer. Vital status was determined through the national death index after ~ 18 years of follow-up (N = 237/597 breast cancer-specific/all-cause deaths). We used Cox proportional hazards regression to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Multiplicative interaction by body mass index (BMI) was evaluated using the likelihood ratio test. RESULTS Ever aspirin use was inversely associated with breast cancer-specific mortality (HR 0.87, 95% CI 0.59-1.29), but positively associated with all-cause mortality (HR 1.21, 95% CI 0.99-1.48); the CIs included the null values. The HRs, however, were more pronounced for the highest level of duration, frequency, regularity, and timing for all-cause, but not breast cancer-specific mortality. Interactions with BMI revealed no significant heterogeneity (pinteraction = 0.37 and pinteraction = 0.36, respectively). CONCLUSION Pre-diagnosis aspirin use was not strongly associated with mortality following breast cancer. The all-cause mortality associations, however, were slightly stronger when we considered patterns of use.
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Affiliation(s)
- Tengteng Wang
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA. .,Department of Epidemiology, UNC, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA.
| | - Humberto Parada
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Kathleen M McClain
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Patrick T Bradshaw
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, 94720, USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Susan L Teitelbaum
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Alfred I Neugut
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.,Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Marilie D Gammon
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
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6
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Low-dose Aspirin, Nonsteroidal Anti-inflammatory Drugs, Selective COX-2 Inhibitors and Breast Cancer Recurrence. Epidemiology 2018; 27:586-93. [PMID: 27007644 DOI: 10.1097/ede.0000000000000480] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and selective COX-2 inhibitors may improve outcomes in breast cancer patients. We investigated the association of aspirin, NSAIDs, and use of selective COX-2 inhibitors with breast cancer recurrence. METHODS We identified incident stage I-III Danish breast cancer patients in the Danish Breast Cancer Cooperative Group registry, who were diagnosed during 1996-2008. Prescriptions for aspirin (>99% low-dose aspirin), NSAIDs, and selective COX-2 inhibitors were ascertained from the National Prescription Registry. Follow-up began on the date of breast cancer primary surgery and continued until the first of recurrence, death, emigration, or 1 January 2013. We used Cox regression models to compute hazard ratios (HR) and corresponding 95% confidence intervals (95% CI) associating prescriptions with recurrence, adjusting for confounders. RESULTS We identified 34,188 breast cancer patients with 233,130 person-years of follow-up. Median follow-up was 7.1 years; 5,325 patients developed recurrent disease. Use of aspirin, NSAIDs, or selective COX-2 inhibitors was not associated with the rate of recurrence (HRadjusted aspirin = 1.0, 95% CI = 0.90, 1.1; NSAIDs = 0.99, 95% CI = 0.92, 1.1; selective COX-2 inhibitors = 1.1, 95% CI = 0.98, 1.2), relative to nonuse. Prediagnostic use of the exposure drugs was associated with reduced recurrence rates (HRaspirin = 0.92, 95% CI = 0.82, 1.0; HRNSAIDs = 0.86, 95% CI = 0.81, 0.91; HRsCOX-2inhibitors = 0.88, 95% CI = 0.83, 0.95). CONCLUSIONS This prospective cohort study suggests that post diagnostic prescriptions for aspirin, NSAIDs, and selective COX-2 inhibitors have little or no association with the rate of breast cancer recurrence. Prediagnostic use of the drugs was, however, associated with a reduced rate of breast cancer recurrence.
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7
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Cronin-Fenton D, Lash TL, Ahern TP, Damkier P, Christiansen P, Ejlertsen B, Sørensen HT. Concurrent new drug prescriptions and prognosis of early breast cancer: studies using the Danish Breast Cancer Group clinical database. Acta Oncol 2018; 57:120-128. [PMID: 29202630 DOI: 10.1080/0284186x.2017.1407040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Myriad reports suggest that frequently used prescription drugs alter the viability of breast cancer cells in pre-clinical studies. Routine use of these drugs, therefore, may impact breast cancer prognosis, and could have important implications for public health. METHODS The Danish Breast Cancer Group (DBCG) clinical database provides high-quality prospectively collected data on breast cancer diagnosis, treatment, and routine follow-up for breast cancer recurrence. Individual-level linkage of DBCG data to other population-based and medical registries in Denmark, including the Danish National Prescription Registry, has facilitated large population-based pharmacoepidemiology studies. A unique advantage of using DBCG data for such studies is the ability to investigate the association of drugs with breast cancer recurrence rather than breast cancer mortality - which may be misclassified - or all-cause mortality. Here we summarize findings from pharmacoepidemiological studies, based on DBCG data, on the association between routinely used prescription drugs and risk of breast cancer recurrence. RESULTS Our findings suggest that concurrent use of glucocorticoids, ACE inhibitors, aspirin, NSAIDs, selective COX-2 inhibitors, digoxin, and opioids has little impact on breast cancer recurrence. Similarly, patients who use SSRIs concurrently with tamoxifen treatment are not at increased risk of recurrence. In contrast, post-diagnostic use of simvastatin, a lipophilic statin, correlates with a decreased risk of breast cancer recurrence, providing a rationale for a prospective randomized clinical trial investigating simvastatin as an adjuvant therapy for breast cancer. CONCLUSION As a whole, findings of pharmacoepidemiological studies based on DBCG data provide reassurance to physicians and healthcare personnel who provide supportive care during and after cancer (including prescriptions for comedications) and to breast cancer survivors for whom the risk of breast cancer recurrence is a major concern.
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Affiliation(s)
| | - Timothy L. Lash
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Thomas P. Ahern
- Departments of Surgery and Biochemistry, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Peer Christiansen
- Breast Unit, Aarhus University Hospital/Randers Regional Hospital, Aarhus, Denmark
- Danish Breast Cancer Cooperative Group, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Henrik T. Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Health Research & Policy (Epidemiology), Stanford University, Stanford, CA, USA
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8
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Araujo JL, Altorki NK, Sonett JR, Rodriguez A, Sungur-Stasik K, Spinelli CF, Neugut AI, Abrams JA. Prediagnosis aspirin use and outcomes in a prospective cohort of esophageal cancer patients. Therap Adv Gastroenterol 2016; 9:806-814. [PMID: 27803735 PMCID: PMC5076766 DOI: 10.1177/1756283x16657985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Esophageal cancer remains associated with poor outcomes, yet little is known regarding factors that influence survival. Aspirin use prior to cancer diagnosis may influence outcomes. We aimed to assess the effects of prediagnosis aspirin use in patients with esophageal cancer. METHODS We conducted a prospective cohort study of newly-diagnosed esophageal cancer patients at two tertiary care centers. We assessed history of prediagnosis aspirin use, and prospectively followed patients and assessed mortality, cause of death, and development of metastases. RESULTS We enrolled 130 patients, the majority of whom were male (81.5%) and had adenocarcinoma (80.8%). Overall, 57 patients (43.9%) were regular aspirin users. In unadjusted analyses, we found no difference in all-cause mortality between aspirin users and nonusers. In multivariate analyses, prediagnosis aspirin use was not associated with all-cause mortality [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.48-1.57] or esophageal cancer-specific mortality (HR 1.07, 95% CI 0.52-2.21). Prediagnosis aspirin use was associated with a significantly increased risk of interval metastasis (HR 3.59, 95% CI 1.08-11.96). CONCLUSIONS In our cohort of esophageal cancer patients, prediagnosis aspirin use was not associated with all-cause or cancer-specific mortality. However, risk of interval metastatic disease was increased among those who took aspirin regularly prediagnosis. Future studies are warranted to assess whether aspirin influences the molecular characteristics of esophageal tumors, with potential prognostic and therapeutic implications.
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Affiliation(s)
- James L. Araujo
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Nasser K. Altorki
- Department of Thoracic Surgery, Weill Cornell Medical Center, New York, NY, USA
| | - Joshua R. Sonett
- Department of Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Adriana Rodriguez
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Cathy F. Spinelli
- Department of Thoracic Surgery, Weill Cornell Medical Center, New York, NY, USA
| | - Alfred I. Neugut
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
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9
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Moris D, Kontos M, Spartalis E, Fentiman IS. The Role of NSAIDs in Breast Cancer Prevention and Relapse: Current Evidence and Future Perspectives. Breast Care (Basel) 2016; 11:339-344. [PMID: 27920627 DOI: 10.1159/000452315] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) have received considerable interest as potential chemopreventive agents. The aim of this review is to summarize the accumulated knowledge on the effect of NSAIDs on breast cancer incidence and natural history, and the underlying pathophysiology. NSAIDs mainly block inflammation by inhibiting cyclooxygenase enzymes, leading to lower prostaglandin synthesis. The latter has been reported to affect breast cancer risk through hormonal and inflammation-related pathways. Intensity, dose, frequency, duration, and timing of administration may also be significant. There is currently enough evidence to support a role of NSAIDs in breast cancer prevention and relapse, which deserves further large-scale experimental and clinical investigation.
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Affiliation(s)
- Demetrios Moris
- 1st Department of Surgery, University of Athens, 'Laikon' General Hospital, Athens, Greece, London, United Kingdom
| | - Michalis Kontos
- 1st Department of Surgery, University of Athens, 'Laikon' General Hospital, Athens, Greece, London, United Kingdom
| | - Eleftherios Spartalis
- 1st Department of Surgery, University of Athens, 'Laikon' General Hospital, Athens, Greece, London, United Kingdom
| | - Ian S Fentiman
- Research Oncology, Bermondsey Wing, Guy's Hospital, London, United Kingdom
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10
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Bradley MC, Black A, Freedman AN, Barron TI. Prediagnostic aspirin use and mortality in women with stage I to III breast cancer: A cohort study in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Cancer 2016; 122:2067-75. [PMID: 27149646 DOI: 10.1002/cncr.30004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a body of evidence indicating that aspirin may reduce the risk of cancer mortality. However, to the authors' knowledge, the optimal exposure timing and mechanism of action remain unclear. In the current study, the authors investigated associations between prediagnostic aspirin use and breast cancer-specific mortality in a US population. METHODS Postmenopausal women diagnosed with stage I to III breast cancer (1993-2009) were identified (2925 women with a total of 18,073 person-years) from the National Cancer Institute's Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Prediagnostic aspirin use (1274 women) was identified from study questionnaires. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs) for associations between aspirin use and breast cancer-specific mortality. Effect modification by lymph node status was evaluated. RESULTS Prediagnostic aspirin use was not found to be associated with lower breast cancer-specific mortality (HR, 0.95; 95% CI, 0.68-1.31 [P = .74]). In analyses stratified by lymph node status, aspirin use was found to be associated with lower breast cancer-specific mortality among women with lymph node-negative tumors (HR, 0.54; 95% CI, 0.32-0.93 [P = 0.02]), but not those with lymph node-positive tumors (HR, 1.41; 95% CI, 0.92-2.16 [P = 0.11]). Tests for interaction were found to be statistically significant (P for interaction =.006). No association was noted between aspirin use and lymph node status. CONCLUSIONS Prediagnostic aspirin use was not found to be associated with a reduction in breast cancer-specific mortality overall. However, effect modification by lymph node status was observed and mortality was found to be reduced by approximately one-half among aspirin users with lymph node-negative disease. This represents a clinically significant reduction in breast cancer mortality. These findings contribute to the understanding of aspirin's mechanism of action in breast cancer. However, further etiologic research to understand this association is warranted. Cancer 2016;122:2067-75. © 2016 American Cancer Society.
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Affiliation(s)
- Marie C Bradley
- Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Amanda Black
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Andrew N Freedman
- Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Thomas I Barron
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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11
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Brenner DR, Brockton NT, Kotsopoulos J, Cotterchio M, Boucher BA, Courneya KS, Knight JA, Olivotto IA, Quan ML, Friedenreich CM. Breast cancer survival among young women: a review of the role of modifiable lifestyle factors. Cancer Causes Control 2016; 27:459-72. [PMID: 26970739 PMCID: PMC4796361 DOI: 10.1007/s10552-016-0726-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 02/06/2016] [Indexed: 02/06/2023]
Abstract
Almost 7 % of breast cancers are diagnosed among women age 40 years and younger in Western populations. Clinical outcomes among young women are worse. Early age-of-onset increases the risk of contralateral breast cancer, local and distant recurrence, and subsequent mortality. Breast cancers in young women (BCYW) are more likely to present with triple-negative (TNBC), TP53-positive, and HER-2 over-expressing tumors than among older women. However, despite these known differences in breast cancer outcomes and tumor subtypes, there is limited understanding of the basic biology, epidemiology, and optimal therapeutic strategies for BCYW. Several modifiable lifestyle factors associated with reduced risk of developing breast cancer have also been implicated in improved prognosis among breast cancer survivors of all ages. Given the treatment-related toxicities and the extended window for late effects, long-term lifestyle modifications potentially offer significant benefits to BCYW. In this review, we propose a model identifying three main areas of lifestyle factors (energy imbalance, inflammation, and dietary nutrient adequacy) that may influence survival in BCYW. In addition, we provide a summary of mechanisms of action and a synthesis of previous research on each of these topics.
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Affiliation(s)
- Darren R Brenner
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 513, Holy Cross Centre, Box ACB, 2210-2nd St. SW, Calgary, AB, T2S 3C3, Canada. .,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Nigel T Brockton
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 513, Holy Cross Centre, Box ACB, 2210-2nd St. SW, Calgary, AB, T2S 3C3, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Michelle Cotterchio
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Beatrice A Boucher
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Kerry S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Julia A Knight
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Ivo A Olivotto
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - May Lynn Quan
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 513, Holy Cross Centre, Box ACB, 2210-2nd St. SW, Calgary, AB, T2S 3C3, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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12
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Thrift AP. Esophageal Adenocarcinoma: The Influence of Medications Used to Treat Comorbidities on Cancer Prognosis. Clin Gastroenterol Hepatol 2015; 13:2225-32. [PMID: 25835331 DOI: 10.1016/j.cgh.2015.03.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 02/07/2023]
Abstract
Esophageal adenocarcinoma has undergone a continuous rise in incidence since the early 1970s and is the fastest rising cancer among white men in the United States. Epidemiologic studies have demonstrated that medications commonly used to treat multiple chronic conditions (for example, aspirin, non-aspirin nonsteroidal anti-inflammatory drugs, and statins) as well as powerful acid suppressants such as proton pump inhibitors are associated with a reduced risk of esophageal adenocarcinoma. The chemopreventive potential of these classes of medications appears to be especially applicable to persons with Barrett's esophagus, the only known premalignant condition for esophageal adenocarcinoma. However, it is not known whether these medications also influence cancer recurrence and cancer-specific mortality in persons diagnosed with esophageal adenocarcinoma. This is an important question because most patients with esophageal adenocarcinoma have 1 or more comorbid conditions at the time of their cancer diagnosis and are receiving medication to treat these conditions. This article summarizes the evidence on the associations between 4 commonly used classes of medications and (1) risk of developing esophageal adenocarcinoma and Barrett's esophagus and (2) risk of cancer recurrence and cancer-specific mortality in patients with esophageal adenocarcinoma.
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Affiliation(s)
- Aaron P Thrift
- Department of Medicine and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
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13
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Brockton NT, Gill SJ, Laborge SL, Paterson AHG, Cook LS, Vogel HJ, Shemanko CS, Hanley DA, Magliocco AM, Friedenreich CM. The Breast Cancer to Bone (B2B) Metastases Research Program: a multi-disciplinary investigation of bone metastases from breast cancer. BMC Cancer 2015; 15:512. [PMID: 26156521 PMCID: PMC4496930 DOI: 10.1186/s12885-015-1528-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/29/2015] [Indexed: 12/18/2022] Open
Abstract
Background Bone is the most common site of breast cancer distant metastasis, affecting 50–70 % of patients who develop metastatic disease. Despite decades of informative research, the effective prevention, prediction and treatment of these lesions remains elusive. The Breast Cancer to Bone (B2B) Metastases Research Program consists of a prospective cohort of incident breast cancer patients and four sub-projects that are investigating priority areas in breast cancer bone metastases. These include the impact of lifestyle factors and inflammation on risk of bone metastases, the gene expression features of the primary tumour, the potential role for metabolomics in early detection of bone metastatic disease and the signalling pathways that drive the metastatic lesions in the bone. Methods/Design The B2B Research Program is enrolling a prospective cohort of 600 newly diagnosed, incident, stage I-IIIc breast cancer survivors in Alberta, Canada over a five year period. At baseline, pre-treatment/surgery blood samples are collected and detailed epidemiologic data is collected by in-person interview and self-administered questionnaires. Additional self-administered questionnaires and blood samples are completed at specified follow-up intervals (24, 48 and 72 months). Vital status is obtained prior to each follow-up through record linkages with the Alberta Cancer Registry. Recurrences are identified through medical chart abstractions. Each of the four projects applies specific methods and analyses to assess the impact of serum vitamin D and cytokine concentrations, tumour transcript and protein expression, serum metabolomic profiles and in vitro cell signalling on breast cancer bone metastases. Discussion The B2B Research Program will address key issues in breast cancer bone metastases including the association between lifestyle factors (particularly a comprehensive assessment of vitamin D status) inflammation and bone metastases, the significance or primary tumour gene expression in tissue tropism, the potential of metabolomic profiles for risk assessment and early detection and the signalling pathways controlling the metastatic tumour microenvironment. There is substantial synergy between the four projects and it is hoped that this integrated program of research will advance our understanding of key aspects of bone metastases from breast cancer to improve the prevention, prediction, detection, and treatment of these lesions.
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Affiliation(s)
- Nigel T Brockton
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 515C, Holy Cross Centre, 2210 2nd St, SW, Calgary, AB, T2S 3C3, Canada. .,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Stephanie J Gill
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 515C, Holy Cross Centre, 2210 2nd St, SW, Calgary, AB, T2S 3C3, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie L Laborge
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 515C, Holy Cross Centre, 2210 2nd St, SW, Calgary, AB, T2S 3C3, Canada
| | - Alexander H G Paterson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Division of Medical Oncology, Tom Baker Cancer Centre, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Linda S Cook
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 515C, Holy Cross Centre, 2210 2nd St, SW, Calgary, AB, T2S 3C3, Canada.,Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Hans J Vogel
- Department of Biological Sciences, Faculty of Science, University of Calgary, Calgary, Alberta, Canada
| | - Carrie S Shemanko
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David A Hanley
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Room 515C, Holy Cross Centre, 2210 2nd St, SW, Calgary, AB, T2S 3C3, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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14
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Barron TI, Murphy LM, Brown C, Bennett K, Visvanathan K, Sharp L. De Novo Post-Diagnosis Aspirin Use and Mortality in Women with Stage I-III Breast Cancer. Cancer Epidemiol Biomarkers Prev 2015; 24:898-904. [PMID: 25791705 DOI: 10.1158/1055-9965.epi-14-1415] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/11/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Aspirin use has been associated with significant reductions in breast cancer-related mortality in some observational studies. However, these studies included women who initiated aspirin use before breast cancer diagnosis. It is unclear whether initiating aspirin use after diagnosis is associated with similar reductions in mortality. This study investigates associations between de novo post-diagnostic aspirin use and all cause, breast cancer-specific mortality. METHODS Women, ages 50 to 80, with a diagnosis of stage I-III breast cancer were identified from Ireland's National Cancer Registry (N = 4,540). Initiation of de novo post-diagnostic aspirin use was identified from linked national prescription refill data (N = 764). Adjusted HRs were estimated for associations between de novo aspirin use and all-cause, breast cancer-specific mortality. RESULTS The median time from diagnosis to aspirin initiation was 1.8 years. The mean number of days' supply of aspirin received was 631, and 95% of users were taking less than 150 mg/d. We found no association between de novo aspirin use and breast cancer-specific mortality [HR, 0.98; 95% confidence interval (CI), 0.74-1.30]. Similar null associations were found in women taking aspirin at high-intensity (HR, 1.03; 95% CI, 0.72-1.47) and women initiating use in the 1.5 years after diagnosis (HR, 1.04; 95% CI, 0.77-1.40). There was no effect modification by estrogen (Pinteraction = 0.81) or progesterone (Pinteraction = 0.41) receptor status. CONCLUSION Initiating aspirin use after a breast cancer diagnosis was not associated with a reduction in breast cancer-specific mortality. IMPACT On the basis of our findings, we suggest that a clearer understanding of aspirin's mechanism of action is needed to help inform the design of future studies in breast cancer.
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Affiliation(s)
- Thomas I Barron
- Trinity Centre for Health Sciences, Trinity College, University of Dublin, Dublin, Ireland. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Laura M Murphy
- Trinity Centre for Health Sciences, Trinity College, University of Dublin, Dublin, Ireland
| | - Chris Brown
- National Cancer Registry Ireland, Cork, Ireland
| | - Kathleen Bennett
- Trinity Centre for Health Sciences, Trinity College, University of Dublin, Dublin, Ireland
| | - Kala Visvanathan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Sidney Kimmel Comprehensive Cancer Centre, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Linda Sharp
- National Cancer Registry Ireland, Cork, Ireland
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Huang XZ, Gao P, Sun JX, Song YX, Tsai CC, Liu J, Chen XW, Chen P, Xu HM, Wang ZN. Aspirin and nonsteroidal anti-inflammatory drugs after but not before diagnosis are associated with improved breast cancer survival: a meta-analysis. Cancer Causes Control 2015; 26:589-600. [DOI: 10.1007/s10552-015-0539-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/13/2015] [Indexed: 12/20/2022]
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Zhong S, Zhang X, Chen L, Ma T, Tang J, Zhao J. Association between aspirin use and mortality in breast cancer patients: a meta-analysis of observational studies. Breast Cancer Res Treat 2015; 150:199-207. [PMID: 25677744 DOI: 10.1007/s10549-015-3300-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/03/2015] [Indexed: 01/22/2023]
Abstract
Previous studies have examined the effect of aspirin intake on the mortality in breast cancer, but the results are inconsistent. A meta-analysis was performed to assess the association with all available studies. Relevant studies were identified by searching PubMed and EMBASE to November 2014. We calculated the summary relative risks (RRs) and 95 % confidence intervals (CIs) using random-effects models. For this meta-analysis, eight cohort studies and two nested case-control studies were included. The analysis included 26,931 participants for postdiagnosis aspirin use and 673,453 participants for prediagnosis aspirin use, followed up over a period of between 2.6 and 30 years. The results showed that patients who used aspirin after diagnosis had a RR of 0.73 (95 % CI = 0.54-0.98, P = 0.04) for breast cancer-specific mortality compared to those who did not use aspirin. Those who used aspirin after diagnosis (vs. non-users) had a RR of 0.84 (95 % CI = 0.63-1.12, P = 0.24) for all-cause mortality. Prediagnostic exposure to aspirin was associated with neither breast cancer-specific mortality (RR = 1.04, 95 % CI = 0.75-1.45, P = 0.80) nor all-cause mortality (RR = 1.04, 95 % CI = 0.61-1.78, P = 0.89). Significant heterogeneity among included studies may be due to a single study, after removing which the significant association between postdiagnosis aspirin use and breast cancer-specific mortality disappeared; however, prediagnosis aspirin use achieved a borderline significant association with risk of all-cause mortality (RR = 0.81, 95 % CI = 0.68-0.97, P = 0.03). In conclusion, aspirin use might has, if any, only a small effect on the survival of breast cancer patients based on current evidence.
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Affiliation(s)
- Shanliang Zhong
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Baiziting 42, Nanjing, 210009, China
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Abstract
PURPOSE OF REVIEW Breast cancer is the most common cancer in women worldwide. This review will focus on current prevention strategies for women at high risk. RECENT FINDINGS The identification of women who are at high risk of developing breast cancer is key to breast cancer prevention. Recent findings have shown that the inclusion of breast density and a panel of low-penetrance genetic polymorphisms can improve risk estimation compared with previous models. Preventive therapy with aromatase inhibitors has produced large reductions in breast cancer incidence in postmenopausal women. Tamoxifen confers long-term protection and is the only proven preventive treatment for premenopausal women. Several other agents, including metformin, bisphosphonates, aspirin and statins, have been found to be effective in nonrandomized settings. SUMMARY There are many options for the prevention of oestrogen-positive breast cancer, in postmenopausal women who can be given a selective oestrogen receptor modulator or an aromatase inhibitor. It still remains unclear how to prevent oestrogen-negative breast cancer, which occurs more often in premenopausal women. Identification of women at high risk of the disease is crucial, and the inclusion of breast density and a panel of genetic polymorphisms, which individually have low penetrance, can improve risk assessment.
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Affiliation(s)
- Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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18
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Sendur MAN, Aksoy S, Ozdemir NY, Zengin N, Altundag K. Impact of acetylsalicylic Acid on the clinicopathological characteristics and prognosis of patients with invasive breast cancer. Breast Care (Basel) 2014; 9:261-6. [PMID: 25404885 DOI: 10.1159/000365952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The impact of acetylsalicylic acid (ASA) on the clinicopathological characteristics of breast cancer has not yet been elucidated in detail; we therefore aimed to investigate the effects of ASA on the clinicopathological characteristics of patients with breast cancer. PATIENTS AND METHODS Patients diagnosed with breast cancer were retrospectively analyzed. Breast cancer patients who were taking ASA at the time of breast cancer diagnosis were enrolled as ASA users (n = 84); matching patients with the same age who were not taking ASA were included as control group (n = 890). RESULTS The median age was 56 (range 34-82) years in both groups. ASA users had a significantly lower incidence of grade II-III tumors compared to non-users (P = 0.02). The other clinicopathological characteristics and treatment histories were similar in both groups. In patients using ASA, the disease-free survival (DFS) rate was 97.3%, 89.4%, and 79.9% and in non-users it was 94.1%, 81.8%, and 70.9% in the 1rst, 3rd, and 5th year, respectively (P = 0.01). In aspirin users, the overall survival rate was 95.0%, 90.6%, and 87.6% and in non-users it was 98.1%, 91.2%, and 85.5% in the 1rst, 3rd, and 5th year, respectively (P = 0.50). CONCLUSION Using ASA at the time of breast cancer diagnosis was associated with significantly improved DFS in breast cancer patients.
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Affiliation(s)
- Mehmet A N Sendur
- Yildirim Beyazit University, Department of Medical Oncology Ankara, Turkey
| | - Sercan Aksoy
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
| | - Nuriye Y Ozdemir
- Yildirim Beyazit University, Department of Medical Oncology Ankara, Turkey
| | - Nurullah Zengin
- Ankara Numune Education and Research Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Kadri Altundag
- Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
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Abstract
Tamoxifen has been shown to reduce the risk of developing estrogen receptor (ER)-positive breast cancer by at least 50%, in both pre- and postmenopausal women. The current challenge is to find new agents with fewer side effects and to find agents that are specifically suitable for premenopausal women with ER-negative breast cancer. Other selective estrogen receptor modulators (SERMs), such as raloxifene, arzoxifene, and lasofoxifene, have been shown to reduce the incidence of breast cancer by 50%-80%. SERMs are interesting agents for the prevention of breast cancer, but longer follow-up is needed for some of them for a complete risk-benefit profile of these drugs. Aromatase inhibitors have emerged as new drugs in the prevention setting for postmenopausal women. In the Mammary Prevention 3 (MAP3) trial, a 65% reduction in invasive breast cancer with exemestane was observed, and the Breast Cancer Intervention Study-II trial, which compared anastrozole with placebo, reported a 60% reduction in those cancers. Although SERMs and aromatase inhibitors have been proven to be excellent agents in the preventive setting specifically for postmenopausal women and ER-positive breast cancer, newer agents have to be found specifically for ER-negative breast cancers, which mostly occur in premenopausal women.
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Affiliation(s)
- Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, UK
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Souza C, Auler P, Reis D, Lavalle G, Ferreira E, Cassali G. Subcutaneous administration of ketoprofen delays Ehrlich solid tumor growth in mice. ARQ BRAS MED VET ZOO 2014. [DOI: 10.1590/1678-6729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ketoprofen, a nonsteroidal anti-inflammatory drug (NSAID) has proven to exert anti-inflammatory, anti-proliferative and anti-angiogenic activities in both neoplastic and non-neoplastic conditions. We investigated the effects of this compound on tumor development in Swiss mice previously inoculated with Ehrlich tumor cells. To carry out this study the solid tumor was obtained from cells of the ascites fluid of Ehrlich tumor re-suspended in physiological saline to give 2.5x106cells in 0.05mL. After tumor inoculation, the animals were separated into two groups (n = 10). The animals treated with ketoprofen 0.1µg/100µL/animal were injected intraperitoneally at intervals of 24h for 10 consecutive days. Animals from the control group received saline. At the end of the experiment the mice were killed and the tumor removed. We analyzed tumor growth, histomorphological and immunohistochemical characteristics for CDC47 (cellular proliferation marker) and for CD31 (blood vessel marker). Animals treated with the ketoprofen 0.1µg/100µL/animal showed lower tumor growth. The treatment did not significantly influence the size of the areas of cancer, inflammation, necrosis and hemorrhage. Moreover, lower rates of tumor cell proliferation were observed in animals treated with ketoprofen compared with the untreated control group. The participation of ketoprofen in controlling tumor malignant cell proliferation would open prospects for its use in clinical and antineoplasic therapy.
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Affiliation(s)
| | | | - D.C. Reis
- Universidade Federal de Minas Gerais
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21
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Non-steroidal anti-inflammatory drug use, hormone receptor status, and breast cancer-specific mortality in the Carolina Breast Cancer Study. Breast Cancer Res Treat 2014; 147:415-21. [PMID: 25151293 DOI: 10.1007/s10549-014-3099-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/07/2014] [Indexed: 01/30/2023]
Abstract
Epidemiologic studies report a protective association between non-steroidal anti-inflammatory drug (NSAID) use and hormone receptor-positive breast cancer risk, a finding consistent with NSAID-mediated suppression of aromatase-driven estrogen biosynthesis. However, the association between NSAID use and breast cancer-specific mortality is uncertain and it is unknown whether this relationship differs by hormone receptor status. This study comprised 935 invasive breast cancer cases, of which 490 were estrogen receptor (ER)-positive, enrolled between 1996 and 2001 in the Carolina Breast Cancer Study. Self-reported NSAID use in the decade prior to diagnosis was categorized by duration and regularity of use. Differences in tumor size, stage, node, and receptor status by NSAID use were examined using Chi-square tests. Associations between NSAID use and breast cancer-specific mortality were examined using age- and race-adjusted Cox proportional hazards analysis. Tumor characteristics did not differ by NSAID use. Increased duration and regularity of NSAID use was associated with reduced breast cancer-specific mortality in women with ER-positive tumors (long-term regular use (≥8 days/month for ≥ 3 years) versus no use; hazard ratio (HR) 0.48; 95 % confidence interval (CI) 0.23-0.98), with a statistically significant trend with increasing duration and regularity (p-trend = 0.036). There was no association for ER-negative cases (HR 1.19; 95 %CI 0.50-2.81; p-trend = 0.891). Long-term, regular NSAID use in the decade prior to breast cancer diagnosis was associated with reduced breast cancer-specific mortality in ER-positive cases. If confirmed, these findings support the hypothesis that potential chemopreventive properties of NSAIDs are mediated, at least in part, through suppression of estrogen biosynthesis.
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Holmes MD, Olsson H, Pawitan Y, Holm J, Lundholm C, Andersson TML, Adami HO, Askling J, Smedby KE. Aspirin intake and breast cancer survival - a nation-wide study using prospectively recorded data in Sweden. BMC Cancer 2014; 14:391. [PMID: 24890520 PMCID: PMC4065077 DOI: 10.1186/1471-2407-14-391] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 05/20/2014] [Indexed: 12/21/2022] Open
Abstract
Background Aspirin (ASA) use has been associated with improved breast cancer survival in several prospective studies. Methods We conducted a nested case–control study of ASA use after a breast cancer diagnosis among women using Swedish National Registries. We assessed prospectively recorded ASA exposure during several different time windows following cancer diagnosis using conditional logistic regression with breast cancer death as the main outcome. Within each six-month period of follow-up, we categorized dispensed ASA doses into three groups: 0, less than 1, and 1 or more daily doses. Results We included 27,426 women diagnosed with breast cancer between 2005 and 2009; 1,661 died of breast cancer when followed until Dec 31, 2010. There was no association between ASA use and breast cancer death when exposure was assessed either shortly after diagnosis, or 3–12 months before the end of follow-up. Only during the period 0–6 months before the end of follow-up was ASA use at least daily compared with non-use associated with a decreased risk of breast cancer death: HR (95% CI) = 0.69 (0.56-0.86). However, in the same time-frame, those using ASA less than daily had an increased risk of breast cancer death: HR (95% CI) = 1.43 (1.09-1.87). Conclusions Contrary to other studies, we did not find that ASA use was associated with a lower risk of death from breast cancer, except when assessed short term with no delay to death/end of follow-up, which may reflect discontinuation of ASA during terminal illness.
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Affiliation(s)
- Michelle D Holmes
- Channing Division of Network Medicine, 181 Longwood Ave, Boston, MA 02115, US.
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Post-diagnostic prescriptions for low-dose aspirin and breast cancer-specific survival: a nested case-control study in a breast cancer cohort from the UK Clinical Practice Research Datalink. Breast Cancer Res 2014; 16:R34. [PMID: 24708725 PMCID: PMC4053148 DOI: 10.1186/bcr3638] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 03/21/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Recent observational studies indicate that post-diagnostic use of aspirin in breast cancer patients may protect against cancer progression perhaps by inhibiting cyclooxygenase-2 dependent mechanisms. Evidence also supports a crucial role for interactions between tumour cells and circulating platelets in cancer growth and dissemination, therefore, use of low-dose aspirin may reduce the risk of death from cancer in breast cancer patients. METHODS A cohort of newly diagnosed breast cancer patients (1998 to 2006) were identified in the UK Clinical Practice Research Datalink (and confirmed by cancer registry linkage). Cancer-specific deaths were identified up to 2011 from Office for National Statistics mortality data. A nested case-control analysis was conducted using conditional logistic regression to compare post-diagnostic aspirin exposure using General Practice prescription data in 1,435 cases (breast cancer deaths) with 5,697 controls (matched by age and year of diagnosis). RESULTS After breast cancer diagnosis, 18.3% of cancer-specific deaths and 18.5% of matched controls received at least one prescription for low-dose aspirin, corresponding to an odds ratio (OR) of 0.98 (95% CI 0.83, 1.15). Adjustment for potential confounders (including stage and grade) had little impact on this estimate. No dose response relationship was observed when the number of tablets was investigated and no associations were seen when analyses were stratified by receipt of prescriptions for aspirin in the pre-diagnostic period, by stage at diagnosis or by receipt of prescriptions for hormone therapy. CONCLUSIONS Overall, in this large population-based cohort of breast cancer patients, there was little evidence of an association between receipt of post-diagnostic prescriptions for low-dose aspirin and breast cancer-specific death. However, information was not available on medication compliance or over-the-counter use of aspirin, which may have contributed to the null findings.
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Breast cancer prevention by antihormones and other drugs: where do we stand? Hematol Oncol Clin North Am 2014; 27:657-72, vii. [PMID: 23915737 DOI: 10.1016/j.hoc.2013.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Breast cancer is the most common cancer in women worldwide. The selective estrogen-receptor (ER) modulators tamoxifen and raloxifene are approved by the Food and Drug Administration for the preventive therapy of breast cancer. Other drugs have shown promise but need further assessment. In the present review, we present an update of the chemoprevention of ER-positive breast cancer and discuss the potential role of metformin and aspirin, 2 drugs other than the specific "antihormones."
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Holmes MD, Chen WY. Hiding in plain view: the potential for commonly used drugs to reduce breast cancer mortality. Breast Cancer Res 2012; 14:216. [PMID: 23227958 PMCID: PMC4053125 DOI: 10.1186/bcr3336] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Many medications have been developed for one purpose but then are found to have other clinical activities. There is tremendous interest in whether non-cancer medications may potentially have effects on breast cancer survival. In this review article, we have presented and evaluated the evidence for several commonly used over-the-counter and prescription medications - including aspirin (and other non-steroidal anti-inflammatory drugs), beta-blockers, angiotensin-converting enzyme inhibitors, statins, digoxin, and metformin - that have been evaluated among breast cancer survivors in prospective studies. Substantial scientific evidence supports the hypothesis that some of these common and relatively safe drugs may reduce breast cancer mortality among those with the disease by an amount that rivals the mortality reduction gained by currently used therapies. In particular, the evidence is strongest for aspirin (approximately 50% reduction), statins (approximately 25% reduction), and metformin (approximately 50% reduction). As these drugs are generic and inexpensive, there is little incentive for the pharmaceutical industry to fund the randomized trials that would show their effectiveness definitively. We advocate that confirmation of these findings in randomized trials be considered a high research priority, as the potential impact on human lives saved could be immense.
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