Association of Non-steroidal Anti-inflammatory Drugs with Colorectal Cancer by Subgroups in the VITamins And Lifestyle (VITAL) Study
Menée à partir d'une enquête réalisée entre 2000 et 2002 auprès de 73 458 participants (âge : de 50 à 76 ans ; période de suivi : 2000-2010), cette étude évalue l'association entre l'utilisation d'anti-inflammatoires non stéroïdiens et le risque de cancer colorectal en fonction des caractéristiques des participants (sexe, indice de masse corporelle, niveau d'activité physique, statut tabagique,...)
Background : There is substantial evidence that use of non-steroidal anti-inflammatory drugs (NSAIDs) reduces the risk of colorectal cancer (CRC), but no subgroup has been identified for which the chemoprevention effect outweighs the risk of side effects. Methods : We tested the interaction between NSAID use and multiple risk factors on CRC risk in the VITAL cohort. A total of 73,458 individuals aged 50-76 completed a questionnaire between 2000 and 2002, and 674 incidental colorectal cancer cases were identified through 2010. Results : In stratified analysis, high use of any type of NSAIDs (4+days/week for 4+ years) was statistically significantly associated with a lower risk of CRC across all subgroups stratified by sex, BMI, physical activity, smoking, alcohol intake, screening and dietary factors. There was a suggestion of stronger associations among men, obese individuals, and heavier drinkers; however, none of these tests for interaction reached statistical significance. The associations were almost identical for subjects with higher overall CRC risk scores (HR: 0.62; 95% CI: 0.49-0.79) and those with lower risk scores (HR: 0.61; 95% CI: 0.42-0.88). Differential effects by cancer subsites and stages were tested. NSAID use was associated with a greater risk reduction of proximal colon cancer vs. distal (p for difference = 0.06) and distant stage vs. local (p for difference = 0.04). Conclusions : The association between high use of NSAIDs and CRC risk does not differ significantly among subgroups. Impact: Our results suggest that NSAIDs have a generally beneficial role in colorectal cancer prevention, largely unmodified by other exposures.