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American Journal of Epidemiology Advance Access published online on October 21, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn255
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTION

Use of Nonsteroidal Antiinflammatory Drugs and Distal Large Bowel Cancer in Whites and African Americans

Sangmi Kim, Christopher Martin, Joseph Galanko, John T. Woosley, Jane C. Schroeder, Temitope O. Keku, Jessie A. Satia, Susan Halabi and Robert S. Sandler

Correspondence to Sangmi Kim, Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Drive, Research Triangle Park, NC 27709 (e-mail: Kims3{at}niehs.nih.gov).

Received for publication March 10, 2008. Accepted for publication July 25, 2008.

Despite the belief that the etiology of and risk factors for rectal cancer might differ from those for colon cancer, relatively few studies have examined rectal cancer in relation to use of nonsteroidal antiinflammatory drugs (NSAIDs). The authors evaluated the association between NSAIDs and distal large bowel cancer in African Americans and whites, using data from a population-based case-control study of 1,057 incident cases of adenocarcinoma of the sigmoid colon, rectosigmoid junction, and rectum and 1,019 controls from North Carolina (2001–2006). NSAID use was inversely associated with distal large bowel cancer in whites (odds ratio (OR) = 0.60, 95% confidence interval (CI): 0.46, 0.79). The inverse association was evident for all types of NSAIDs but was slightly stronger with prescription NSAIDs, particularly selective cyclooxygenase 2 inhibitors (OR = 0.38, 95% CI: 0.25, 0.56). Compared with whites, a relatively weak inverse association was found in African Americans (OR = 0.87, 95% CI: 0.55, 1.40), although odds ratio heterogeneity by race could not be confirmed (P = 0.21). In addition, the strength of the association with NSAIDs varied by tumor location, suggesting more potent effects for rectal and rectosigmoid cancers than for sigmoid cancer. The chemopreventive potential of NSAIDs might differ by population and by tumor characteristics.

anti-inflammatory agents, non-steroidal; colonic neoplasms; colorectal neoplasms; intestine, large; population groups; rectal neoplasms

Abbreviations: CI, confidence interval; COX-2, cyclooxygenase 2; NSAID, nonsteroidal antiinflammatory drug; OR, odds ratio


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