Regular aspirin use and risk of multiple myeloma: a prospective analysis in the Health Professionals Follow-up Study and Nurses' Health Study
Menée sur deux cohortes indépendantes incluant 51 529 hommes âgés de 40 à 75 ans et 121 701 femmes âgées de 30 à 55 ans (durée de suivi : 2 395 458 personnes-années), cette étude prospective évalue l'association entre l'utilisation régulière d'aspirine et le risque de myélome multiple
Multiple myeloma (MM) is a lethal malignancy with an unknown etiology and no prevention strategy. Aspirin inhibits several pathways mediated by nuclear factor (NF)-
κB, cyclooxygenase (COX)-2, or their targets that are important in MM pathogenesis. We conducted prospective analyses in the Health Professionals Follow-up Study and Nurses' Health Study cohorts to examine whether regular aspirin use influences MM risk. We used biennially updated data to characterize aspirin use from baseline through a cancer diagnosis, death, or 2008. We applied a four-year lag in exposure classification to diminish the influence of preclinical MM on aspirin use habits. We obtained hazard ratios (HR) and 95% confidence intervals (CI) from multivariable proportional hazard models to assess the association of aspirin use with MM risk. We tested for trend across increasing quantity and duration of use. During 2,395,458 person-years, we confirmed 328 incident MM diagnoses, including 265 with prospective information on typical aspirin dose and frequency. Participants with a cumulative average of
≥5 adult strength (325-mg) tablets/week had a 39% lower MM risk than non-users (HR, 95% CI: 0.61, 0.39-0.94; tablets/week, P-trend=0.06). Persons with ≥11 years of continuous regular aspirin use also had a lower MM risk (HR, 95% CI: 0.63, 0.41-0.95; duration, P-trend=0.17). The associations appeared stronger in men than in women, possibly reflecting gender differences in aspirin use patterns. This prospective study of aspirin use and MM supports an etiologic role for aspirin-inhibited (i.e., NF-
κB- or COX-2-mediated) pathways. The utility of aspirin for MM chemoprevention warrants further evaluation.