|
E-mail this page to a friend!
Oral Cancer Risk Cut in Half, Heart Risk Doubled by
Most NSAIDs
Aspirin was only exception to increased heart risk in
20-year study
Oct. 7, 2005 - An analysis of 20 years of data on
the health of over 900 adults has found that long-term use of
traditional nonsteroidal anti-inflammatory drugs (NSAIDs), such as
aspirin, ibuprofen and naproxen, cuts the risk for oral cancer in
smokers by half. However, use of these pain relievers - with the
exception of aspirin - for 6 months or more also doubled users' risks
for cardiovascular death, according to collaborative research published
online today by The Lancet.
"Our findings highlight how a commonly used drug
can have a benefit from the standpoint of cancer prevention but can also
have side effects - in this case, an increased risk for cardiovascular
death," said co-researcher Dr. Andrew Dannenberg, the Henry R. Erle,
M.D., Professor of Medicine at Weill Medical College of Cornell
University and Director of Cancer Prevention at NewYork-Presbyterian/Weill
Cornell.
The findings "also support moves by the U.S. Food
and Drug Administration, which recently mandated special 'black box'
warning labels on all NSAID pain relievers except aspirin, warning
consumers of potential cardiovascular side effects linked to long-term
use," added lead researcher Dr. Jon Sudbψ, a senior consultant in the
Department of Medical Oncology and Radiotherapy at Norwegian Radium
Hospital.
The new FDA-mandated labeling applies to both the
over-the-counter and prescription versions of these drugs. The agency's
decision followed earlier moves in 2004 and 2005, when two COX-2
enzyme-specific NSAIDs were withdrawn from the market - first Vioxx was
voluntarily recalled by Merck in September 2004, and then the FDA
ordered the recall of Bextra earlier this spring.
The research team took a retrospective look at data
collected prospectively from 1975 to 1995 on more than 123,000 adults
participating in the Norwegian Health Survey. The survey tracks
participant lifestyles, habits, and long-term health outcomes, and is
one of the richest such databases in the world.
Dr. Sudbψ and colleagues narrowed their focus to
454 people with oral cancer and 454 others without such malignancies
matched for age and sex. All of the individuals had a history of heavy
smoking.
"Specifically, we were looking for associations
between the long-term use of traditional, non-COX-2-specific NSAIDs and
the risk of oral cancer, since previous work has suggested that these
drugs can lower risks for other malignancies, such as colon cancer,"
explained co-researcher Dr. Scott M. Lippman, Ellen F. Knisely
Distinguished Chair and Chairman of the Department of Clinical Cancer
Prevention at M. D. Anderson Cancer Center.
In fact, the researchers did find a correlation:
Adults who were prescribed NSAIDs such as aspirin, ibuprofen, naproxen,
indomethacin, piroxicam, and ketoprofen for 6 months or more (most of
them for much longer periods, with 88 percent taking NSAIDs for 5 years
or more) were at a 53 percent lowered risk for oral malignancies
compared with those who did not take the drugs over the long-term.
"But there was a puzzling finding," Dr. Sudbψ said.
"Even though the drugs appeared to protect users from oral cancer, we
saw no added benefit overall in terms of prolongation of life or reduced
mortality. So something was potentially tipping the balance the other
way."
Digging deeper, they identified that "something" as
cardiovascular disease: According to the study, long-term use of
traditional NSAIDs, except for cardiovascular-dose aspirin, doubled
users' risk for cardiovascular death.
This type of elevated heart risk had already been
noted with a subclass of NSAIDs called COX-2 inhibitors, drugs like the
now-recalled Vioxx and Bextra and a third (still available) painkiller,
Celebrex, which target a specific enzyme linked to inflammation.
"But our data support the recent FDA move to put a
warning label on the entire class of NSAID medications, except for
aspirin - labeling that alerts consumers that long-term use of these
drugs might raise their cardiovascular risk," Dr. Lippman said.
The investigators stressed that the study does have
its limitations. First, the NSAIDs used in the study were available to
Norwegians via prescription only, and it's not clear whether dosages
used by the survey participants were similar in strength to popular
American over-the-counter products like Aleve (naproxen), Motrin
(ibuprofen), or Advil (ibuprofen).
In addition, Dr. Dannenberg and co-author Dr. J.
Jack Lee, Professor of Biostatistics at the M. D. Anderson Cancer
Center, stressed that although the data themselves were collected
prospectively, the study remains a relatively small, retrospective
effort. "It's tough to make sweeping generalizations until the results
are confirmed by much larger, prospective trials," they said.
So, might long-term use of traditional NSAIDs still
be right for some people - According to the study investigators, a
careful risk-benefit assessment is required, and that's a question best
left to a patient and his or her doctor.
The study was conducted by researchers at the
Norwegian Radium Hospital and The National Hospital in Oslo; University
of Science and Technology, Trondheim, Norway; NewYork-Presbyterian
Hospital/Weill Cornell Medical Center in New York City; The University
of Texas M. D. Anderson Cancer Center in Houston; and the University of
Helsinki. The findings were presented earlier this year at the annual
meeting of the American Association for Cancer Research.
The study was funded by grants from the U.S.
National Cancer Institute, the Center for Cancer Prevention Research,
the Norwegian Cancer Society, the Research Foundation of the Norwegian
Radium Hospital, Astrid and Birger Torsteds Legat, and the Research
Council of Norway.
Co-researchers include Dr. Jan Folkvard Evensen,
Wanja Kildal, MSc, Prof. Albrecht Reith, and Dr. Nina Flatner, of
Norwegian Radium Hospital, Oslo; Simone Sagen, MPH, of The Research
Foundation of the Norwegian Radium Hospital, Oslo; Dr. Jon Mork, of The
National Hospital and The Norwegian Cancer Registry, Oslo; Dr. Li Mao
and X. Zhou, MSc, of the University of Texas M. D. Anderson Cancer
Center, Houston; Prof. A. Sudbψ, of the University of Science and
Technology, Trondheim, Norway; and Dr. A. Ristmδki, of the University of
Helsinki.
Click to More Senior News on the
Front Page
Copyright: SeniorJournal.com |
