title: Low-dose Aspirin, Nonsteroidal Anti-inflammatory Drugs, Selective COX-2 Inhibitors and Breast Cancer Recurrence.
abstract: Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and selective COX-2 inhibitors may improve outcomes in breast cancer patients. We investigated the association of aspirin, NSAIDs, and use of selective COX-2 inhibitors with breast cancer recurrence.
  
  
  
  We identified incident stage I-III Danish breast cancer patients in the Danish Breast Cancer Cooperative Group registry, who were diagnosed during 1996-2008. Prescriptions for aspirin (>99% low-dose aspirin), NSAIDs, and selective COX-2 inhibitors were ascertained from the National Prescription Registry. Follow-up began on the date of breast cancer primary surgery and continued until the first of recurrence, death, emigration, or 1 January 2013. We used Cox regression models to compute hazard ratios (HR) and corresponding 95% confidence intervals (95% CI) associating prescriptions with recurrence, adjusting for confounders.
  
  
  
  We identified 34,188 breast cancer patients with 233,130 person-years of follow-up. Median follow-up was 7.1 years; 5,325 patients developed recurrent disease. Use of aspirin, NSAIDs, or selective COX-2 inhibitors was not associated with the rate of recurrence (HRadjusted aspirin = 1.0, 95% CI = 0.90, 1.1; NSAIDs = 0.99, 95% CI = 0.92, 1.1; selective COX-2 inhibitors = 1.1, 95% CI = 0.98, 1.2), relative to nonuse. Prediagnostic use of the exposure drugs was associated with reduced recurrence rates (HRaspirin = 0.92, 95% CI = 0.82, 1.0; HRNSAIDs = 0.86, 95% CI = 0.81, 0.91; HRsCOX-2inhibitors = 0.88, 95% CI = 0.83, 0.95).
  
  
  
  This prospective cohort study suggests that post diagnostic prescriptions for aspirin, NSAIDs, and selective COX-2 inhibitors have little or no association with the rate of breast cancer recurrence. Prediagnostic use of the drugs was, however, associated with a reduced rate of breast cancer recurrence.
authors.affiliation: From the aDepartment of Clinical Epidemiology, Aarhus University, Aarhus, Denmark; bDepartments of Surgery and Biochemistry, University of Vermont, Burlington, VT; cDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; dBreast and Endocrine Section, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark; eDanish Breast Cancer Cooperative Group, Copenhagen, Denmark; and fRigshospitalet, Copenhagen, Denmark.
authors.forename: Deirdre P
authors.initials: DP
authors.lastname: Cronin-Fenton
authors.forename: Uffe
authors.initials: U
authors.lastname: Heide-Jørgensen
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Ahern
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Lash
authors.forename: Peer
authors.initials: P
authors.lastname: Christiansen
authors.forename: Bent
authors.initials: B
authors.lastname: Ejlertsen
authors.forename: Henrik T
authors.initials: HT
authors.lastname: Sørensen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D003718:Denmark / Q000453:epidemiology; D004008:Diclofenac / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D065840:Protective Factors; D012042:Registries
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D004008:Diclofenac; D001241:Aspirin; D007052:Ibuprofen