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NSAID use may cut oral cancer risk in smokers.

ANAHEIM, CALIF. -- Long-term use of nonsteroidal anti-inflammatory drugs was associated with a 50% reduction in oral cancer in heavy smokers in a population-based, nested, case-control study, Jon Sudbo, M.D., reported at the annual meeting of the American Association for Cancer Research.

But despite this significant reduction in oral cancer--which carries a 5-10 year mortality rate of about 50%--there was no overall decrease in mortality in the cohort.

The decrease in oral cancer was apparently offset by a doubling in the risk of cardiovascular death among long-term NSAID users, Dr. Sudbo, of the University of Oslo (Norway), and his colleagues found.

The study combined data from the Norwegian Institute of Public Health and the Norwegian Cancer Registry. Among about 123,000 individuals, 9,241 had smoking histories of 15 pack-years or more. Among those individuals, 454 who were diagnosed with squamous cell carcinoma of the oral cavity were matched by gender and age with 454 controls.

The study looked at long-term use of six NSAIDs (aspirin, ibuprofen, naproxen, indomethacin, piroxicam, and ketoprofen) and acetaminophen. Long-term use was defined as daily use for at least 6 months, but most individuals in the study used NSAIDs daily for at least 5 years.

After adjustment for a number of risk factors, NSAID use had a hazard ratio of 0.49 for the development of oral cancer, a statistically significant 51% reduction. Long-term acetaminophen use was not associated with a significant reduction in risk. Reduction in oral cancer risk with NSAID use was most pronounced in individuals with less than 30 pack-years of smoking.

Long-term use of any NSAID increased cardiovascular deaths with a statistically significant hazard ratio of 2.06, compared with nonusers. "Many of these deaths could have been avoided had we monitored the patients with respect to cardiovascular disease, but nobody thought of it," Dr. Sudbo said at a press briefing.

"One of the lessons we're learning in chemoprevention these days," he added, is that "if you want to do cancer preventive intervention ... you really need to reserve it for the few at extremely high risk, not for the many at medium or low risk."
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Author:Finn, Robert
Publication:Internal Medicine News
Geographic Code:1USA
Date:Jul 15, 2005
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