title: Associations of NSAID and paracetamol use with risk of primary liver cancer in the Clinical Practice Research Datalink.
abstract: Liver cancer incidence has been rising rapidly in Western countries. Nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol are widely-used analgesics that may modulate the risk of liver cancer, but population-based evidence is limited. We conducted a case-control study (1195 primary liver cancer cases and 4640 matched controls) within the United Kingdom's Clinical Practice Research Datalink to examine the association between the use of prescription NSAIDs and paracetamol and development of liver cancer. Multivariable-adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. Overall, ever-use of NSAIDs was not associated with risk of liver cancer (aOR=1.05, 95% CI=0.88-1.24), regardless of recency and intensity of use. Use of paracetamol was associated with a slightly increased risk of liver cancer (aOR=1.18, 95% CI=1.00-1.39), particularly among individuals with body mass index<25kg/m(2) (aOR=1.56, 95% CI=1.17-2.09). Our results suggest that NSAID use was not associated with liver cancer risk in this population. Ever-use of paracetamol may be associated with slightly higher liver cancer risk, but results should be interpreted cautiously due to methodological limitations. Given that paracetamol is a widely-used analgesic, further examination of its relationship with liver cancer is warranted.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9774, USA. Electronic address: baiyu.yang@nih.gov.
authors.forename: Baiyu
authors.initials: B
authors.lastname: Yang
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9774, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Petrick
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9774, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Boston Collaborative Drug Surveillance Program and Boston University School of Public Health, Lexington, MA, 02421, USA.
authors.forename: Katrina Wilcox
authors.initials: KW
authors.lastname: Hagberg
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9774, USA; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, 20892-9783, USA.
authors.forename: Vikrant V
authors.initials: VV
authors.lastname: Sahasrabuddhe
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9774, USA.
authors.forename: Barry I
authors.initials: BI
authors.lastname: Graubard
authors.affiliation: Boston Collaborative Drug Surveillance Program and Boston University School of Public Health, Lexington, MA, 02421, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Jick
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9774, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: McGlynn
mesh_terms: D000082:Acetaminophen; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D016022:Case-Control Studies; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy; D016017:Odds Ratio; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen
keywords: Analgesics; Case-control study; Liver cancer; Medical records database