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Risk of non-Hodgkin lymphoma and use of non-steroidal anti-inflammatory drugs

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Abstract

Background: Risk factors for non-Hodgkin lymphoma (NHL) are largely unknown. Several studies have examined the relation of non-steroidal anti-inflammatory drug (NSAID) use to the risk of NHL, with inconsistent results. Methods: We examined NSAID use among 529 newly diagnosed NHL cases and 2013 controls interviewed from 1977 to 2002 in our Case–Control Surveillance Study. Results: The odds ratio for NHL among subjects whose regular NSAID use began at least one year prior to hospital admission compared to never users was 0.9 (95% confidence interval (CI): 0.6–1.3). Odds ratios for less than five years, five to less than 10 years, and 10 or more years of regular use were 1.2 (95% CI: 0.8–1.9), 1.0 (95% CI: 0.5–2.1), and 0.4 (95% CI: 0.1–1.0), respectively. The results were similar for regular aspirin use. Conclusion: Our results add to the body of data suggesting that NSAIDs do not increase the risk of NHL and even suggest the possibility of protection by long-term use.

Introduction

The incidence of non-Hodgkin lymphoma (NHL) has increased by more than 70% over the past 20 years, and it is now the fifth most common malignancy in the US population, but risk factors for NHL are largely unknown [1]. Several studies have examined the relation of use of non-steroidal anti-inflammatory drugs (NSAIDs) to the risk of NHL, with inconsistent results [2], [3], [4], [5], [6], [7], [8]. Of five case–control studies [2], [3], [5], [6], [8], three found use of NSAIDs increased the risk of NHL [2], [3], [6], one reported no association [8], and one, the largest with 1281 cases, suggested that use of NSAIDs for at least 4 consecutive weeks was associated with a reduced risk of NHL in both men (OR = 0.74, 95% CI: 0.53–1.0) and women (OR = 0.63, 95% CI: 0.45–0.89)[5]. In a cohort study with 131 NHL cases identified over seven years of follow-up [7], the relative risks for ever use of aspirin alone, non-aspirin NSAIDs, or any NSAIDs were 2.31 (95% CI: 1.04–5.15), 3.39 (95% CI: 1.38–8.32), and 2.82 (95% CI: 1.24–6.39), respectively. However, no dose-response relation was observed for frequency of use, and no data were presented on the effect of duration of use. We examined the relation of NSAID use to the risk of NHL using data from our hospital-based Case–Control Surveillance Study [9], [10], [11], [12], [13], [14].

Section snippets

Materials and methods

Subjects were recruited from patients admitted to hospitals in New York, Philadelphia, Boston and Baltimore from 1977 to 2002. Nurse-interviewers administered standard questionnaires to obtain information on demographic factors, medical and reproductive history, family history of cancer, lifestyle factors, and medication use. Histories of drug use were elicited by questions about 42 indications that included those for which NSAIDs are used (e.g., pain, headache, and arthritis). For each episode

Results

No association was found with non-regular use of either NSAIDs or aspirin (Table 1). Compared to non-users, the odds ratio for NHL among subjects whose regular NSAID use began at least 1 year before admission was 0.9 (95% CI: 0.6–1.3). When duration of regular NSAID use that began at least one year prior to hospital admission was further divided into three categories, odds ratios for less than 5 years, 5 to less than 10 years, and 10 or more years of use were 1.2 (95% CI: 0.8–1.9), 1.0 (95% CI:

Discussion

Our study, with a relatively large number of newly diagnosed cases of NHL, found that regular use of NSAIDs overall or aspirin specifically was not associated with an increased risk of NHL. In fact, among the long-term regular users, the risk of NHL appeared to decrease, which is consistent with the findings from the one of the largest case–control studies [5].

In the current study, we did not collect data on histological type of NHL. Thus, we were unable to assess whether effects of regular

Acknowledgements

This work was supported by grant CA45762 from the National Cancer Institute. Additional support was provided by Grant FD-U-00082 from the Food and Drug Administration.

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