Nonaspirin NSAID Use Linked to Risk for Renal Cell Cancer

Laurie Barclay, MD

September 12, 2011

September 12, 2011 — Long-term use of nonaspirin anti-inflammatory drugs (NSAIDs) is linked to a risk for renal cell cancer (RCC), according to an analysis of data from 2 prospective studies reported in the September 12 issue of the Archives of Internal Medicine.

"Epidemiologic data suggest that analgesic use increases the risk of ...RCC, but few prospective studies have been published," write Eunyoung Cho, ScD, from Harvard Medical School and Brigham and Women's Hospital in Boston, Massachusetts, and colleagues. "We investigated the association between analgesic use and RCC in 2 large prospective studies."

Use of aspirin, other NSAIDs, and acetaminophen was determined in 1990 in the Nurses' Health Study and in 1986 in the Health Professionals Follow-up Study, as well as every 2 years subsequently. In the Nurses' Health Study, 77,525 women were followed up for 16 years, and in the Health Professionals Follow-up Study, 49,403 men were followed up for 20 years.

Although use of aspirin and acetaminophen was not associated with the risk for RCC, regular use of nonaspirin NSAIDs was associated with an increased risk for RCC. At baseline, the pooled multivariate relative risk (RR) was 1.51 (95% confidence interval [CI], 1.12 - 2.04). For users vs nonusers of nonaspirin NSAIDs, the absolute risk differences were 9.15 per 100,000 person-years in women and 10.92 per 100,000 person-years in men.

Duration of nonaspirin NSAID use was linked to RCC risk in a dose-response relationship (P < .001 for trend). Compared with nonregular use, the pooled multivariate RRs were 0.81 (95% CI, 0.59 - 1.11) for less than 4 years' use, 1.36 (95% CI, 0.98 - 1.89) for 4 to less than 10 years' use, and 2.92 (95% CI, 1.71 - 5.01) for at least 10 years' use.

"Our prospective data suggest that longer duration of use of nonaspirin NSAIDs may increase the risk of RCC," the study authors write.

Limitations of this study include possible residual confounding, confounding by indication, confounding by past use of phenacetin, and incomplete information on NSAID dose.

"Risks and benefits should be considered in deciding whether to use analgesics; if our findings are confirmed, an increased risk of RCC should also be considered," the study authors conclude.

In an accompanying editor's note, Kirsten L. Johansen, MD, notes that approximately 60 million people in the United States use NSAIDs regularly.

"The study by Cho et al uses prospective data from 2 different cohorts to estimate the risk of renal cell carcinoma related to NSAID use and reports a pooled multivariate relative risk of 1.51 (95% confidence interval, 1.12-2.04) for nonaspirin NSAID use, with a dose-response relationship based on duration of use," Dr. Johansen writes. "Although the absolute risk differences between users and nonusers of NSAIDS were quite low, we find the results compelling in light of the widespread use of these drugs."

The National Institutes of Health, the Kidney Center Association, and the Dana-Farber/Harvard Cancer Center Kidney Cancer Specialized Programs of Research Excellence supported this study. The study authors have disclosed no relevant financial relationships.

Arch Intern Med. 2011;171:1487-1493, 1493.

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