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American Journal of Epidemiology Advance Access originally published online on July 7, 2009
American Journal of Epidemiology 2009 170(4):507-514; doi:10.1093/aje/kwp162
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Nonsteroidal Antiinflammatory Drugs and Risk of Gastric Adenocarcinoma

The Multiethnic Cohort Study

Meira Epplein, Abraham M. Y. Nomura, Lynne R. Wilkens, Brian E. Henderson and Laurence N. Kolonel

Correspondence to Dr. Meira Epplein, Epidemiology Program, Cancer Research Center of Hawaii, University of Hawaii, 1236 Lauhala Street, Honolulu, HI 96813 (e-mail: mepplein{at}crch.hawaii.edu).

Received for publication March 20, 2009. Accepted for publication May 13, 2009.

In many epidemiologic studies, investigators have reported an inverse relation between nonsteroidal antiinflammatory drugs (NSAIDs) and colon cancer, but fewer researchers have examined the relation with gastric cancer. Cases for this study consisted of incident gastric adenocarcinomas (n = 643) identified between 1993 and 2004 among members of the Multiethnic Cohort (Hawaii and Los Angeles, California). Aspirin and nonaspirin NSAID use was assessed on the basis of a self-administered questionnaire. Multivariate-adjusted hazards ratios and 95% confidence intervals were calculated using Cox proportional hazards regression. Compared with no regular use, regular use of aspirin was associated with a decreased risk of distal gastric cancer (hazard ratio (HR) = 0.73, 95% confidence interval (CI): 0.61, 0.89; Ptrend = 0.009), but use of nonaspirin NSAIDs was not (HR = 1.00, 95% CI: 0.81, 1.24; Ptrend = 0.99). The inverse association with regular aspirin use was observed only for intestinal-type distal gastric adenocarcinoma (HR = 0.66, 95% CI: 0.47, 0.95; Ptrend = 0.01), as opposed to diffuse-type distal gastric adenocarcinoma (HR = 0.92, 95% CI: 0.53, 1.60; Ptrend = 0.45). In this study, the authors found aspirin use to be inversely associated with distal gastric adenocarcinoma, particularly of the intestinal type.

adenocarcinoma; anti-inflammatory agents, non-steroidal; aspirin; stomach neoplasms

Abbreviations: CI, confidence interval; COX, cyclooxygenase; HR, hazard ratio; NSAID, nonsteroidal antiinflammatory drug


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