NSAIDs May Reduce Lung Cancer Risk

Laurie Barclay, MD

March 18, 2003

March 18, 2003 — Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) reduces the risk of lung cancer for former or current smokers, according to the results of a case-control study reported in the April 1 issue of Cancer.

"Because lung carcinoma is the leading cause of cancer deaths, the possibility that commonly used pain medication can reduce the rates should be explored," write Joshua E. Muscat, PhD, from the American Health Foundation in Valhalla, New York, and colleagues.

In this hospital-based study of 1,038 study patients and 1,002 control patients, using NSAIDs at least three times weekly for at least one year decreased risk of lung carcinoma by 32%, regardless of histology (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.53 - 0.89). However, the risk varied with smoking status. Odds ratio was 1.28 (95% CI, 0.73 - 2.25) in never-smokers and 0.60 (95% CI, 0.45 - 0.80) in current or former smokers.

Aspirin had similar smoking-specific risk estimates to those for all NSAIDs, but the association of reduced lung cancer risk was found only in men and not in women.

Although it is unclear why the protective effect of NSAIDs was limited to smokers, the authors suggest that smoking might induce cyclooxygenase (COX)-2 expression. Cigarette tar extracts increase COX activity in rat lung cells, and COX-2 activity is higher in lung cancer tissue of smokers than in nonsmokers. Clinical trials are underway studying selective COX-2 inhibitors in cancer.

"These results provide the strongest evidence to date for a chemoprotective effect of NSAIDs," the authors write.

Cancer. 2003;97:1732-1736

Reviewed by Gary D. Vogin, MD

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