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[Cancer Research 53, 1322-1327, March 15, 1993]
© 1993 American Association for Cancer Research

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Aspirin Use and Risk of Fatal Cancer

Michael J. Thun, Mohan M. Namboodiri, Eugenia E. Calle, W. Dana Flanders and Clark W. Heath, Jr.

American Cancer Society, Atlanta, Georgia 30329 [M. J. T., M. M. N., E. E. C., C. W. H.], and Epidemiology Division, Emory University School of Public Health, Atlanta, Georgia 30322 [W. D. F.]

Aspirin and other nonsteroidal antiinflammatory drugs inhibit prostagiandin synthesis and tumor growth in many experimental systems, but it is unclear which of these tumor models are relevant to humans. We have reported reduced risk of fatal colon cancer among persons who used aspirin in a large prospective study. This analysis examines other fatal cancers in relation to aspirin among 635,031 adults in that study who provided information in 1982 on the frequency and duration of their aspirin use and did not report cancer. Death rates were measured through 1988. Death rates decreased with more frequent aspirin use for cancers of the esophagus, stomach, colon, and rectum but not generally for other cancers. For each digestive tract cancer, death rates were approximately 40% lower among persons who used aspirin 16 times/month or more for at least 1 year compared to those who used no aspirin. The trend of decreasing risk with more frequent aspirin use was strongest among persons who had used aspirin for 10 years or more; it remained statistically significant, except for esophageal cancer, in multivariate analyses that adjusted for other known risk factors. Biases such as early detection or aspirin avoidance among cases do not appear to explain the results. Our data suggest that regular, prolonged use of aspirin may reduce the risk of fatal cancer of the esophagus, stomach, colon, and rectum. Future epidemiological and basic research should examine all digestive tract cancers in considering the chemopreventive or therapeutic potential of nonsteroidal antiinflammatory drugs.

Received 8/27/92. Accepted 1/11/93.




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R. E. Harris, R. T. Chlebowski, R. D. Jackson, D. J. Frid, J. L. Ascenseo, G. Anderson, A. Loar, R. J. Rodabough, E. White, and A. McTiernan
Breast Cancer and Nonsteroidal Anti-Inflammatory Drugs: Prospective Results from the Women's Health Initiative
Cancer Res., September 15, 2003; 63(18): 6096 - 6101.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
F. G. Buchanan, D. Wang, F. Bargiacchi, and R. N. DuBois
Prostaglandin E2 Regulates Cell Migration via the Intracellular Activation of the Epidermal Growth Factor Receptor
J. Biol. Chem., September 12, 2003; 278(37): 35451 - 35457.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
K.-T. Kuo, K.-C. Chow, Y.-C. Wu, C.-S. Lin, H.-W. Wang, W.-Y. Li, and L.-S. Wang
Clinicopathologic significance of cyclooxygenase-2 overexpression in esophageal squamous cell carcinoma
Ann. Thorac. Surg., September 1, 2003; 76(3): 909 - 914.
[Abstract] [Full Text] [PDF]


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FASEB J.Home page
Q. JIANG and B. N. AMES
{gamma}-Tocopherol, but not {alpha}-tocopherol, decreases proinflammatory eicosanoids and inflammation damage in rats
FASEB J, May 1, 2003; 17(8): 816 - 822.
[Abstract] [Full Text] [PDF]


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CarcinogenesisHome page
S. M. Fischer, C. J. Conti, J. Viner, C.M. Aldaz, and R. A. Lubet
Celecoxib and difluoromethylornithine in combination have strong therapeutic activity against UV-induced skin tumors in mice
Carcinogenesis, May 1, 2003; 24(5): 945 - 952.
[Abstract] [Full Text] [PDF]


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CarcinogenesisHome page
T. Kawamori, N. Uchiya, T. Sugimura, and K. Wakabayashi
Enhancement of colon carcinogenesis by prostaglandin E2 administration
Carcinogenesis, May 1, 2003; 24(5): 985 - 990.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
H. Sawaoka, D. A. Dixon, J. A. Oates, and O. Boutaud
Tristetraprolin Binds to the 3'-Untranslated Region of Cyclooxygenase-2 mRNA. A POLYADENYLATION VARIANT IN A CANCER CELL LINE LACKS THE BINDING SITE
J. Biol. Chem., April 11, 2003; 278(16): 13928 - 13935.
[Abstract] [Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
T. W. Johnson, K. E. Anderson, D. Lazovich, and A. R. Folsom
Association of Aspirin and Nonsteroidal Anti-inflammatory Drug Use with Breast Cancer
Cancer Epidemiol. Biomarkers Prev., December 1, 2002; 11(12): 1586 - 1591.
[Abstract] [Full Text] [PDF]


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CarcinogenesisHome page
X. Chen, N. Li, S. Wang, J. Hong, M. Fang, J. Yousselfson, P. Yang, R. A. Newman, R. A. Lubet, and C. S. Yang
Aberrant arachidonic acid metabolism in esophageal adenocarcinogenesis, and the effects of sulindac, nordihydroguaiaretic acid, and {alpha}-difluoromethylornithine on tumorigenesis in a rat surgical model
Carcinogenesis, December 1, 2002; 23(12): 2095 - 2102.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
B. S. Zweifel, T. W. Davis, R. L. Ornberg, and J. L. Masferrer
Direct Evidence for a Role of Cyclooxygenase 2-derived Prostaglandin E2 in Human Head and Neck Xenograft Tumors
Cancer Res., November 15, 2002; 62(22): 6706 - 6711.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
O. C. Trifan, W. F. Durham, V. S. Salazar, J. Horton, B. D. Levine, B. S. Zweifel, T. W. Davis, and J. L. Masferrer
Cyclooxygenase-2 Inhibition with Celecoxib Enhances Antitumor Efficacy and Reduces Diarrhea Side Effect of CPT-11
Cancer Res., October 15, 2002; 62(20): 5778 - 5784.
[Abstract] [Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
M. F. Leitzmann, M. J. Stampfer, J. Ma, J. M. Chan, G. A. Colditz, W. C. Willett, and E. Giovannucci
Aspirin Use in Relation to Risk of Prostate Cancer
Cancer Epidemiol. Biomarkers Prev., October 1, 2002; 11(10): 1108 - 1111.
[Abstract] [Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
T. L. Vaughan, A. R. Kristal, P. L. Blount, D. S. Levine, P. C. Galipeau, L. J. Prevo, C. A. Sanchez, P. S. Rabinovitch, and B. J. Reid
Nonsteroidal Anti-inflammatory Drug Use, Body Mass Index, and Anthropometry in Relation to Genetic and Flow Cytometric Abnormalities in Barrett's Esophagus
Cancer Epidemiol. Biomarkers Prev., August 1, 2002; 11(8): 745 - 752.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
P. S. Carlton, R. Gopalakrishnan, A. Gupta, B. W. Liston, S. Habib, M. A. Morse, and G. D. Stoner
Piroxicam Is an Ineffective Inhibitor of N-Nitrosomethylbenzylamine-induced Tumorigenesis in the Rat Esophagus
Cancer Res., August 1, 2002; 62(15): 4376 - 4382.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
S. Arico, S. Pattingre, C. Bauvy, P. Gane, A. Barbat, P. Codogno, and E. Ogier-Denis
Celecoxib Induces Apoptosis by Inhibiting 3-Phosphoinositide-dependent Protein Kinase-1 Activity in the Human Colon Cancer HT-29 Cell Line
J. Biol. Chem., July 26, 2002; 277(31): 27613 - 27621.
[Abstract] [Full Text] [PDF]


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J. Pharmacol. Exp. Ther.Home page
S. J. Baek, L. C. Wilson, C.-H. Lee, and T. E. Eling
Dual Function of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Inhibition of Cyclooxygenase and Induction of NSAID-Activated Gene
J. Pharmacol. Exp. Ther., June 1, 2002; 301(3): 1126 - 1131.
[Abstract] [Full Text] [PDF]


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NEJMHome page
M. S. Lauer
Aspirin for Primary Prevention of Coronary Events
N. Engl. J. Med., May 9, 2002; 346(19): 1468 - 1474.
[Full Text] [PDF]


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Reproductive SciencesHome page
A. R. Munkarah, R. Morris, P. Baumann, G. Deppe, J. Malone, M. P. Diamond, and G. M. Saed
Effects of Prostaglandin E2 on Proliferation and Apoptosis of Epithelial Ovarian Cancer Cells
Reproductive Sciences, May 1, 2002; 9(3): 168 - 173.
[Abstract] [PDF]


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JNCI J Natl Cancer InstHome page
M. J. Thun, S. J. Henley, and C. Patrono
Nonsteroidal Anti-inflammatory Drugs as Anticancer Agents: Mechanistic, Pharmacologic, and Clinical Issues
J Natl Cancer Inst, February 20, 2002; 94(4): 252 - 266.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
P. Pradono, R. Tazawa, M. Maemondo, M. Tanaka, K. Usui, Y. Saijo, K. Hagiwara, and T. Nukiwa
Gene Transfer of Thromboxane A2 Synthase and Prostaglandin I2 Synthase Antithetically Altered Tumor Angiogenesis and Tumor Growth
Cancer Res., January 1, 2002; 62(1): 63 - 66.
[Abstract] [Full Text] [PDF]


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Am. J. Clin. Nutr.Home page
Q. Jiang, S. Christen, M. K Shigenaga, and B. N Ames
{gamma}-Tocopherol, the major form of vitamin E in the US diet, deserves more attention
Am. J. Clinical Nutrition, December 1, 2001; 74(6): 714 - 722.
[Abstract] [Full Text]


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ANN INTERN MEDHome page
U. Ladabaum, C. L. Chopra, G. Huang, J. M. Scheiman, M. E. Chernew, and A. M. Fendrick
Aspirin as an Adjunct to Screening for Prevention of Sporadic Colorectal Cancer: A Cost-Effectiveness Analysis
Ann Intern Med, November 6, 2001; 135(9): 769 - 781.
[Abstract] [Full Text] [PDF]


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Cancer Res.Home page
A. H. Klimp, H. Hollema, C. Kempinga, A. G. J. van der Zee, E. G. E. de Vries, and T. Daemen
Expression of Cyclooxygenase-2 and Inducible Nitric Oxide Synthase in Human Ovarian Tumors and Tumor-associated Macrophages
Cancer Res., October 1, 2001; 61(19): 7305 - 7309.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
L. B. Signorello, W. Ye, J. P. Fryzek, L. Lipworth, J. F. Fraumeni Jr., W. J. Blot, J. K. McLaughlin, and O. Nyren
Nationwide Study of Cancer Risk Among Hip Replacement Patients in Sweden
J Natl Cancer Inst, September 19, 2001; 93(18): 1405 - 1410.
[Abstract] [Full Text] [PDF]


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Infect. Immun.Home page
T. I. Kim, Y. C. Lee, K. H. Lee, J. H. Han, C. Y. Chon, Y. M. Moon, J. K. Kang, and I. S. Park
Effects of Nonsteroidal Anti-Inflammatory Drugs on Helicobacter pylori-Infected Gastric Mucosae of Mice: Apoptosis, Cell Proliferation, and Inflammatory Activity
Infect. Immun., August 1, 2001; 69(8): 5056 - 5063.
[Abstract] [Full Text] [PDF]


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QJMHome page
J.R. Paterson and J.R. Lawrence
Salicylic acid: a link between aspirin, diet and the prevention of colorectal cancer
QJM, August 1, 2001; 94(8): 445 - 448.
[Abstract] [Full Text] [PDF]


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CarcinogenesisHome page
X. Chen and C. S. Yang
Esophageal adenocarcinoma: a review and perspectives on the mechanism of carcinogenesis and chemoprevention
Carcinogenesis, August 1, 2001; 22(8): 1119 - 1129.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
K. Saukkonen, O. Nieminen, B. van Rees, S. Vilkki, M. Harkonen, M. Juhola, J.-P. Mecklin, P. Sipponen, and A. Ristimaki
Expression of Cyclooxygenase-2 in Dysplasia of the Stomach and in Intestinal-type Gastric Adenocarcinoma
Clin. Cancer Res., July 1, 2001; 7(7): 1923 - 1931.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
S. Srivastava, M. Verma, and D. E. Henson
Biomarkers for Early Detection of Colon Cancer
Clin. Cancer Res., May 1, 2001; 7(5): 1118 - 1126.
[Abstract] [Full Text]


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Mol. Pharmacol.Home page
S. J. Baek, K.-S. Kim, J. B. Nixon, L. C. Wilson, and T. E. Eling
Cyclooxygenase Inhibitors Regulate the Expression of a TGF-{beta} Superfamily Member That Has Proapoptotic and Antitumorigenic Activities
Mol. Pharmacol., April 1, 2001; 59(4): 901 - 908.
[Abstract] [Full Text]


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Cancer Res.Home page
M. D. Boudreau, K. H. Sohn, S. H. Rhee, S. W. Lee, J. D. Hunt, and D. H. Hwang
Suppression of Tumor Cell Growth Both in Nude Mice and in Culture by n-3 Polyunsaturated Fatty Acids: Mediation through Cyclooxygenase-independent Pathways
Cancer Res., February 1, 2001; 61(4): 1386 - 1391.
[Abstract] [Full Text]


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Cancer Epidemiol. Biomarkers Prev.Home page
E. J. Jacobs, C. J. Connell, A. V. Patel, A. Chao, C. Rodriguez, J. Seymour, M. L. McCullough, E. E. Calle, and M. J. Thun
Vitamin C and Vitamin E Supplement Use and Colorectal Cancer Mortality in a Large American Cancer Society Cohort
Cancer Epidemiol. Biomarkers Prev., January 1, 2001; 10(1): 17 - 23.
[Abstract] [Full Text]


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Cancer Res.Home page
K. Akre, L. B. Signorello, L. Engstrand, R. Bergström, S. Larsson, B. I. Eriksson, and O. Nyrén
Risk for Gastric Cancer after Antibiotic Prophylaxis in Patients Undergoing Hip Replacement
Cancer Res., November 1, 2000; 60(22): 6376 - 6380.
[Abstract] [Full Text]


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Cancer Res.Home page
R. F. Souza, K. Shewmake, D. G. Beer, B. Cryer, and S. J. Spechler
Selective Inhibition of Cyclooxygenase-2 Suppresses Growth and Induces Apoptosis in Human Esophageal Adenocarcinoma Cells
Cancer Res., October 1, 2000; 60(20): 5767 - 5772.
[Abstract] [Full Text]


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Cancer Epidemiol. Biomarkers Prev.Home page
M. J. Thun, E. E. Calle, C. Rodriguez, and P. A. Wingo
Epidemiological Research at the American Cancer Society
Cancer Epidemiol. Biomarkers Prev., September 1, 2000; 9(9): 861 - 868.
[Full Text]


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Rheumatology (Oxford)Home page
F. A. Wollheim
Selective Cox-2 inhibition in man--therapeutic breakthrough or cosmetic advance?
Rheumatology, September 1, 2000; 39(9): 935 - 938.
[Full Text] [PDF]


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Am. J. Pathol.Home page
M. Komhoff, Y. Guan, H. W. Shappell, L. Davis, G. Jack, Y. Shyr, M. O. Koch, S. B. Shappell, and M. D. Breyer
Enhanced Expression of Cyclooxygenase-2 in High Grade Human Transitional Cell Bladder Carcinomas
Am. J. Pathol., July 1, 2000; 157(1): 29 - 35.
[Abstract] [Full Text] [PDF]


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BMJHome page
M J S Langman, K K Cheng, E A Gilman, and R J Lancashire
Effect of anti-inflammatory drugs on overall risk of common cancer: case-control study in general practice research database
BMJ, June 17, 2000; 320(7250): 1642 - 1646.
[Abstract] [Full Text]




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