NSAID Use May Reduce Breast Cancer Recurrence Risk Among the Obese

What You Need to Know: For postmenopausal women with estrogen-receptor-positive breast cancer who are receiving hormone therapy and who are overweight or obese, the risk for disease recurrence appears to be significantly lower if they also take nonsteroidal anti-inflammatory drug (NSAIDs), such as aspirin, on a daily basis. In addition, these women remain cancer-free for a longer period of time.

The Study: The risk for breast cancer recurrence was 52% lower among overweight and obese women who took NSAIDs than in those who did not. Mean disease-free survival was also longer in the women who took NSAIDs (78.5 vs 50.6 months).

“NSAIDs may improve response to hormone therapy, thereby allowing more women to remain on anti-estrogen therapy rather than needing to change to chemotherapy and deal with the associated side effects and complications,” said Linda A. deGraffenried, PhD, associate professor of nutritional sciences at The University of Texas in Austin, in a statement.

Researchers retrospectively analyzed the medical records of patients treated at the Cancer Therapy and Research Center at The University of Texas Health Science Center and the START Center for Cancer Care, both in San Antonio. Of the 440 women in the study cohort, 159 used NSAIDs and 281 did not.

  • For recurrence of breast cancer of any kind (local, contralateral, distal, or metastasis), NSAID users had nearly half the chance of recurring (relative risk 0.48);
  • The reduction in risk for recurrence of approximate 50% held when factors such as the use of statins and omega-3 fatty acid — both anti-inflammatory agents — was considered

“Overweight or obese women diagnosed with breast cancer are facing a worse prognosis than normal-weight women,” Dr. deGraffenried said in a statement. “We believe that obese women are facing a different disease. There are changes at the molecular level. We seek to modulate the disease-promoting effects of obesity.”

To explore this issue, the researchers conducted cell-culture experiments. They created a tumor environment with cancer cells, fat cells, and immune cells (which promote inflammation), and showed that the expression of several inflammatory molecules — such as COX-2, prostaglandin E₂, arachidonic acid, and aromatase — increased in obese patients. However, when NSAIDs were added to the cell culture, levels of these inflammatory molecules decreased.

This study indicates that inflammation is a significant mechanistic component of breast cancer in overweight and obese women. This inflammation might make aromatase inhibitors less effective in preventing recurrence in these patients.

My Take: These results are preliminary and patients should never undertake any treatment without consulting with their physician. Prospective studies to determine the efficacy of adding NSAIDs to anti-estrogen therapy begin in 2015. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Cancer Res. 2014 74; 4446-4457; NSAID Use May Reduce Breast Cancer Recurrence in Obese. Medscape. Aug 14, 2014.

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Harvard AB Yale MD UPenn Radiation Oncology Radiation Oncologist, Seattle area

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