title: Analgesic use and the risk of kidney cancer: a meta-analysis of epidemiologic studies.
abstract: Analgesics are the most commonly used over-the-counter drugs worldwide with certain analgesics having cancer prevention effect. The evidence for an increased risk of developing kidney cancer with analgesic use is mixed. Using a meta-analysis design of available observational epidemiologic studies, we investigated the association between analgesic use and kidney cancer risk. We searched the MEDLINE and EMBASE databases to identify eligible case-control or cohort studies published in English until June 2012 for three categories of analgesics: acetaminophen, aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs). Study-specific effect estimates were pooled to compute an overall relative risk (RR) and its 95% confidence interval (CI) using a random-effects model for each category of the analgesics. We identified 20 studies (14 with acetaminophen, 13 with aspirin and five with other NSAIDs) that were performed in six countries, including 8,420 cases of kidney cancer. Use of acetaminophen and non-aspirin NSAIDs were associated with an increased risk of kidney cancer (pooled RR: 1.28; 95% CI: 1.15-1.44 and 1.25; 95% CI: 1.06-1.46, respectively). For aspirin use, we found no overall increased risk (pooled RR: 1.10; 95% CI: 0.95-1.28), except for non-US studies (five studies, pooled RR: 1.17; 95% CI: 1.04-1.33). Similar increases in risks were seen with higher analgesic intake. In this largest meta-analysis to date, we found that acetaminophen and non-aspirin NSAIDs are associated with a significant risk of developing kidney cancer. Further work is needed to elucidate biologic mechanisms behind these findings.
authors: Kidney Cancer Center, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors: Toni K
authors: TK
authors: Choueiri
authors: Youjin
authors: Y
authors: Je
authors: Eunyoung
authors: E
authors: Cho
mesh_terms: D000700:Analgesics / Q000009:adverse effects*; D016021:Epidemiologic Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors
chemical_list: D000700:Analgesics
keywords: acetaminophen; analgesics; aspirin; kidney cancer; non-aspirin non-steroidal anti-inflammatory drugs
references: Control Clin Trials. 1986 Sep;7(3):177-88
references: 3802833
references: Epidemiology. 1996 Jul;7(4):358-62
references: 8793360
references: Hematol Oncol Clin North Am. 2011 Aug;25(4):737-52
references: 21763965
references: N Engl J Med. 2005 Dec 8;353(23):2477-90
references: 16339096
references: Can Urol Assoc J. 2009 Aug;3(4):323-330
references: 19672448
references: Ann Intern Med. 2007 Mar 6;146(5):376-89
references: 17339623
references: Am J Kidney Dis. 1994 Jul;24(1):17-24
references: 8023820
references: Eur J Cancer Prev. 2002 Apr;11(2):171-8
references: 11984136
references: Oncol Rep. 2005 Apr;13(4):559-83
references: 15756426
references: J Natl Cancer Inst. 2008 Oct 15;100(20):1439-47
references: 18840819
references: Br J Cancer. 2003 Jun 2;88(11):1687-92
references: 12771981
references: Int J Cancer. 1994 Nov 15;59(4):467-70
references: 7960214
references: Eur J Cancer Prev. 2010 Jul;19(4):272-4
references: 20351553
references: Epidemiology. 1994 Mar;5(2):138-46
references: 8172988
references: Arch Intern Med. 2011 Sep 12;171(16):1487-93
references: 21911634
references: Cancer Causes Control. 1998 Jan;9(1):83-8
references: 9486467
references: Mutat Res. 2006 Apr 11;596(1-2):143-50
references: 16464479
references: Biometrics. 1994 Dec;50(4):1088-101
references: 7786990
references: JAMA. 2002 Jan 16;287(3):337-44
references: 11790213
references: CA Cancer J Clin. 2012 Jan-Feb;62(1):10-29
references: 22237781
references: Int J Cancer. 1988 Jul 15;42(1):13-6
references: 3391702
references: Cancer Epidemiol Biomarkers Prev. 2011 Dec;20(12):2637-41
references: 21994402
references: Int J Epidemiol. 1994 Oct;23(5):923-30
references: 7860172
references: J Natl Cancer Inst. 2007 Apr 18;99(8):608-15
references: 17440162
references: Prog Exp Tumor Res. 2003;37:1-24
references: 12795046
references: Int J Cancer. 2002 Jan 1;97(1):96-101
references: 11774249
references: Carcinogenesis. 1984 Apr;5(4):525-31
references: 6142774
references: Natl Cancer Inst Monogr. 1985 Dec;69:217-22
references: 3834336
references: BMJ. 1997 Sep 13;315(7109):629-34
references: 9310563
references: Br J Cancer. 1999 Oct;81(3):542-8
references: 10507783
references: JAMA. 2000 Apr 19;283(15):2008-12
references: 10789670
references: Int J Cancer. 1995 Jan 27;60(3):345-9
references: 7829242
references: Hematol Oncol Clin North Am. 2011 Aug;25(4):651-65
references: 21763961
references: Br J Cancer. 2003 Mar 10;88(5):684-8
references: 12618874
references: Int J Cancer. 1993 Jan 21;53(2):245-9
references: 8425761
references: Ann Oncol. 2012 Jun;23(6):1403-15
references: 22517822
references: BMJ. 1989 Nov 18;299(6710):1247-50
references: 2513898
references: Cancer Causes Control. 1993 Mar;4(2):101-10
references: 8481488
references: Nat Rev Clin Oncol. 2012 Apr 03;9(5):259-67
references: 22473097
references: Epidemiology. 2001 Nov;12(6):690-4
references: 11679798
references: BMJ. 2003 Sep 6;327(7414):557-60
references: 12958120