Nonsteroidal anti-inflammatory drugs and lung cancer risk: a population-based case control study.
BACKGROUND
It remains unknown whether nonsteroidal anti-inflammatory drugs (NSAIDs) confer a protective effect against lung cancer development. We examined the relationship between NSAID exposure and subsequent lung cancer development in a large statewide, population-based cohort.


METHODS
Nested case-control study in the Tennessee Medicaid population from 1990 to 2000.


METHODS
Lung cancer cases were identified using a statewide computerized claims database. Each time a case was identified, age- and sex-matched controls were randomly selected from the available source population. A detailed pharmacy database quantified nonsteroidal anti-inflammatory drug (NSAID) exposure during the 5 years before cancer diagnosis, and conditional logistic regression was used to examine the relationship between NSAID exposure and lung cancer development. Identical analyses were repeated in a subpopulation of high-risk individuals with chronic obstructive pulmonary disease (COPD).


RESULTS
303,399 persons were enrolled in the study population. During 1.9 million person-years of follow-up (median 6.3 years per person), 3,370 lung cancer cases were identified. Among those ever using NSAIDs, the adjusted odds ratio of developing lung cancer was 1.03 (95% confidence interval: 0.94-1.12). Among those using >24 months of NSAIDs in the 5 years before lung cancer diagnosis, the adjusted odds ratio for lung cancer was 0.96 (95% confidence interval: 0.82-1.11), and no protective effect was demonstrated in any NSAID exposure stratum. Similarly, among the 2519 high-risk individuals with chronic obstructive pulmonary disease, no significant protective effect from NSAIDs was noted.


CONCLUSIONS
This large statewide, population-based study did not demonstrate a protective effect of NSAIDs on lung cancer development in either the general or high-risk chronic obstructive pulmonary disease populations.
Wall
Richard J
RJ
Veterans Affairs National Quality Scholars Program, Tennessee Valley Healthcare System, Nashville, TN, USA. brickw@u.washington.edu
Shyr
Yu
Y
Smalley
Walter
W
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012306:Risk; D013714:Tennessee / Q000453:epidemiology
D000894:Anti-Inflammatory Agents, Non-Steroidal