title: Thyroid Cancer and Nonsteroidal Anti-Inflammatory Drug Use: A Pooled Analysis of Patients Older Than 40 Years of Age.
abstract: BACKGROUND
  Cyclooxygenase (COX-2) has been associated with tumor growth and metastasis in several cancers, including thyroid cancer. For this reason, several investigators have studied COX-2 inhibitors in preclinical models of thyroid cancer and found antineoplastic effects. Thus, the primary aim of this study was to assess if the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a reduced incidence of thyroid cancer. A second aim of the study was to determine additional risk or protective factors for thyroid cancer.
  
  
  METHODS
  Three large prospective population-based studies (the NIH-AARP Diet and Health Study; the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial; and the U.S. Radiologic Technologists Study) were pooled to investigate the association between self-reported frequency of aspirin and nonaspirin NSAID use one year prior to baseline (no use, ≤ 2/week, >2-6/week, and ≥ 7/week) and subsequent risk of thyroid cancer. A Cox regression proportional hazard model was used to estimate aggregated hazard ratios (HR) adjusted for cohort, sex, race/ethnicity, weight, smoking status, and alcohol intake.
  
  
  RESULTS
  There were 388,577 participants in the pooled cohort, with 481 cases of thyroid cancer. No significant risk reduction was observed with regular use of nonaspirin NSAIDs (HR = 1.14 [confidence interval (CI) 0.84-1.55]), and/or regular use of aspirin (HR = 1.06 [CI 0.82-1.39]). The multivariate regression analysis confirmed as previously reported in the literature that female sex, obesity class I (body mass index [BMI] = 30-34.99 kg/m(2)), and obesity class II (BMI = 35-35.99 kg/m(2)) were independently associated with an increased thyroid cancer risk. Current smoking status and moderate and excessive alcohol use were also confirmed as independent risk factors associated with a reduced thyroid cancer risk.
  
  
  CONCLUSIONS
  Neither nonaspirin NSAIDs nor aspirin use is associated with a reduced risk of thyroid cancer. Women and obesity are associated with an increased risk of thyroid cancer, whereas smoking and alcohol use are associated with decreased risk of thyroid cancer.
authors.affiliation: 1 Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Patel
authors.affiliation: 2 Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Cari M
authors.initials: CM
authors.lastname: Kitahara
authors.affiliation: 3 Division of Public Health Sciences, Washington University School of Medicine , St. Louis, Missouri.|4 Division of Cancer Epidemiology and Genetics, Nutrition Epidemiology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Yikyung
authors.initials: Y
authors.lastname: Park
authors.affiliation: 4 Division of Cancer Epidemiology and Genetics, Nutrition Epidemiology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Liao
authors.affiliation: 4 Division of Cancer Epidemiology and Genetics, Nutrition Epidemiology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Martha
authors.initials: M
authors.lastname: Linet
authors.affiliation: 1 Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
authors.affiliation: 1 Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Naris
authors.initials: N
authors.lastname: Nilubol
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D016016:Proportional Hazards Models; D065840:Protective Factors; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D013964:Thyroid Neoplasms / Q000453:epidemiology*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal