NSAIDs Won't Shield Against Skin Cancer
MONDAY Feb. 15, 2010 -- Countering prior indications that long-term use of NSAID painkillers might help reduce cancer risk, a new study suggests that these anti-inflammatory drugs offer no protection against a common skin cancer.
Previous research had suggested that routine use of NSAIDs -- including such over-the counter medications as Advil, Motrin, aspirin, Celebrex and Aleve (but not Tylenol) -- is associated with a reduced risk for the onset of colorectal, breast, prostate and lung cancer.
"Although there is some prior evidence, mostly laboratory-based, to suggest that NSAIDs can reduce the risk for the particular type of skin cancer called cutaneous squamous cell carcinoma, in our study, we didn't find that association," said the lead author, Dr. Maryam M. Asgari, an investigator in the research division at Kaiser Permanente Northern California (KPNC) in Oakland, Calif.
The study, which was supported by the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases and the U.S. National Cancer Institute, are published in the Feb. 15 online issue of the Archives of Dermatology.
To explore the potential connection between NSAIDs and skin cancer risk, Asgari and her colleagues administered questionnaires to a randomly selected pool of 415 patients between the ages of 43 and 85 who were diagnosed with skin cancer in 2004 and sought care at KPNC.
This group's self-reported NSAID-use history between 1994 and 2004 was stacked up against that of a group of 415 healthy patients. Both groups were similar in terms of age, race and gender. As well, records detailing pharmacy-dispensed NSAID patterns among all the patients were also examined for links to skin cancer incidence.
The authors noted that 61 percent of all the patients reported routine use of NSAIDs in the decade preceding the study. Specifically, 48 percent said they had used aspirin, 18 percent ibuprofen, 5 percent naproxen (ie, Aleve), and 4 percent nabumetone (Relafen).
But regardless of dosage used, type of medication taken, and/or whether NSAIDs were pharmacy-dispensed, the anti-inflammatory drugs were not found to be associated with a drop in skin cancer risk.
In fact, those patients who had taken NSAIDs for a relatively short period of time --anywhere from one to three years-- actually appeared to have a slightly increased risk for developing squamous cell carcinoma, the researchers said.
They concluded that NSAIDs did not seem to offer any protective effect with respect to skin cancer, and -- given the potential toxic side-effects of long-term NSAID use -- they suggested that patients at higher risk for skin cancer should be directed towards other safer, and perhaps more effective, interventions.
"We were surprised at the lack of NSAID protection," Asgari remarked. "Particularly when we saw an increased risk for skin cancer associated with the short-term use of NSAIDs. But actually that's not been unheard of, and I think there could be various explanations for this. Maybe people using NSAIDs short-term have other co-morbidities that make them more prone to having a weaker immune system and having poorer health. And also there are some forms of NSAIDs that do make you sun-sensitive, and more prone to getting DNA damage. That might be another explanation. But we were surprised."
However, Eric Jacobs, strategic director of pharmaco-epidemiology for the American Cancer Society, said Asgari's findings were not surprising.
"Results from this study are consistent with those of most previous studies," he said. "The best way to lower the risk of non-melanoma skin cancer, including squamous cell carcinoma, is to limit your exposure to strong sunlight -- for example by wearing a hat and using sunscreen -- and to avoid using tanning beds and sun lamps."
Dr. Alfred I. Neugut, head of cancer prevention and control at Columbia University's cancer center in New York City, also found the study's results unsurprising.
"Cutaneous squamous cell carcinoma is not your typical, run-of-the-mill cancer," noted Neugut, who is also co-director of cancer prevention at New York Presbyterian Hospital. "While it's one of the most common cancers -- maybe the most common -- it's not aggressive, not systemic, and related almost exclusively to sun exposure. So it is not really in the same category of cancers as, say, colorectal cancer or breast cancer."
Neugut added, "The fact that they found [NSAID use] has no effect is logical."
Posted: February 2010
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