Long-Term NSAID Use Cuts Oral Cancer Risk, but Raises Cardiovascular Mortality
By Anthony J. Brown, MD
NEW YORK (Reuters Health) Oct 07 - Long-term use of NSAIDs can reduce the risk of oral cancer, but careful monitoring is required because these drugs may also raise the risk of death from cardiovascular disease, according to a report in the October 7th online issue of The Lancet.
"When we analyzed the data, NSAID use was tied to a reduced risk of oral cancer, similar to what has been seen with colorectal cancer, but that didn't translate into a survival benefit," lead author Dr. Jon Sudbo, from The Norwegian Radium Hospital in Norway, told Reuters Health. "So, we went back and looked for an explanation and that's when we found a doubling of the risk of cardiovascular death."
The COX enzymes are thought to play a role in the development of oral cancer. Therefore, treatment with NSAIDs, which are known to block COX activity, could help prevent this malignancy. Two previous studies have investigated this topic, but they only included aspirin use and yielded conflicting results.
The findings are based on a comparison of NSAID use between 454 heavy smokers with oral cancer and 454 matched smokers without cancer. Overall, 263 subjects had used NSAIDs for at least 6 months, 83 had used acetaminophen, and 562 had used neither drug.
NSAID use cut the risk of oral cancer by 53% (p < 0.0001), whereas acetaminophen use did not have a significant effect. Moreover, the reduction in risk tended to increase with duration of NSAID use, reaching a maximum of 70% for 15 or more years of use.
Consistent with previous reports, smoking cessation was also tied to a reduced risk of oral cancer (p < 0.0001), the authors note.
As noted, long-term use of NSAIDs, but not acetaminophen, raised the risk of cardiovascular mortality by twofold.
Despite the concern over adverse cardiovascular effects, Dr. Sudbo believes that there may still be a role for NSAIDs in preventing oral cancer. "If you want to use these agents on a long-term basis (for any indication), you need to monitor patients carefully for cardiovascular events. If you're using them for cancer prevention, be sure you select patients at high risk for cancer."
Unfortunately, he said his team was unable to identify any factors that could predict which patients are likely to experience cardiovascular morbidity and mortality when using NSAIDs.
Dr. Sudbo said that his team is now planning a randomized trial to further investigate the anti-oral cancer effect of NSAID use. If all goes well, he expects the study to be completed in 7 years.
Lancet 2005.
NEW YORK (Reuters Health) Oct 07 - Long-term use of NSAIDs can reduce the risk of oral cancer, but careful monitoring is required because these drugs may also raise the risk of death from cardiovascular disease, according to a report in the October 7th online issue of The Lancet.
"When we analyzed the data, NSAID use was tied to a reduced risk of oral cancer, similar to what has been seen with colorectal cancer, but that didn't translate into a survival benefit," lead author Dr. Jon Sudbo, from The Norwegian Radium Hospital in Norway, told Reuters Health. "So, we went back and looked for an explanation and that's when we found a doubling of the risk of cardiovascular death."
The COX enzymes are thought to play a role in the development of oral cancer. Therefore, treatment with NSAIDs, which are known to block COX activity, could help prevent this malignancy. Two previous studies have investigated this topic, but they only included aspirin use and yielded conflicting results.
The findings are based on a comparison of NSAID use between 454 heavy smokers with oral cancer and 454 matched smokers without cancer. Overall, 263 subjects had used NSAIDs for at least 6 months, 83 had used acetaminophen, and 562 had used neither drug.
NSAID use cut the risk of oral cancer by 53% (p < 0.0001), whereas acetaminophen use did not have a significant effect. Moreover, the reduction in risk tended to increase with duration of NSAID use, reaching a maximum of 70% for 15 or more years of use.
Consistent with previous reports, smoking cessation was also tied to a reduced risk of oral cancer (p < 0.0001), the authors note.
As noted, long-term use of NSAIDs, but not acetaminophen, raised the risk of cardiovascular mortality by twofold.
Despite the concern over adverse cardiovascular effects, Dr. Sudbo believes that there may still be a role for NSAIDs in preventing oral cancer. "If you want to use these agents on a long-term basis (for any indication), you need to monitor patients carefully for cardiovascular events. If you're using them for cancer prevention, be sure you select patients at high risk for cancer."
Unfortunately, he said his team was unable to identify any factors that could predict which patients are likely to experience cardiovascular morbidity and mortality when using NSAIDs.
Dr. Sudbo said that his team is now planning a randomized trial to further investigate the anti-oral cancer effect of NSAID use. If all goes well, he expects the study to be completed in 7 years.
Lancet 2005.
posted by Ricardo Pocurull at 12:39 PM
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