Nonaspirin NSAIDs May Raise RCC Risk

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DENVER—Regular use of nonaspirin non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen may increase the risk for renal cell carcinoma (RCC), according to researchers.

In a prospective study of more than 140,000 individuals, investigators found that the risk for RCC was 52% greater among subjects who used nonaspirin NSAIDs twice a week or more and 46% greater for those who took acetaminophen twice a week or more compared with subjects who used these medications less frequently.

If these findings are confirmed in future studies, it may be possible to lower RCC rates by decreasing the use of these medications, said lead investigator Eunyoung Cho, ScD, an epidemiologist at Brigham and Women's Hospital and Assistant Professor of Medicine at Harvard Medical School in Boston. She and her colleagues observed no association between aspirin and RCC risk.

“There have been some small prospective studies with aspirin, but this is the first prospective study of nonaspirin analgesics in relation to renal cell carcinoma,” Dr. Cho said.

Dr. Cho, who presented the study findings here at the American Association for Cancer Research annual meeting, said previous epidemiologic studies have pointed to an association between analgesic use and an increased risk for the development of RCC, but most of these studies have been retrospective.

Acetaminophen is a major metabolite of phenacetin, an analgesic compound banned in the United States and worldwide in the mid-1980s because of its carcinogenic effect in the kidney.

In addition, studies have linked long-term use of acetaminophen to a decline in renal function as well as an increased risk of CKD and hypertension. Conversely, studies have shown that regular aspirin use is associated with a reduced risk of some malignancies, including colorectal, breast, ovarian, and lung cancer.

Dr. Cho and her colleagues analyzed data from the Nurses' Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS). The NHS included 121,700 women aged 30-55 years at the start of the study in 1976.

The HPFS included 51,529 male health professionals (dentists, veterinarians, pharmacists, optometrists, osteopathic physicians, and podiatrists). Subjects were aged 40-75 at the start of the study in 1986.

All participants in both studies provided information on analgesic use at baseline (1990 in the NHS and 1986 in the HPFS). During 14 years of follow-up for the NHS cohort and 20 years of follow-up for the HPFS cohort, the researchers documented 324 cases of RCC (146 women and 178 men).

“We expected that aspirin would be inversely associated with renal cell carcinoma,” Dr. Cho told Renal & Urology News. “We thought there would be some protection, but that was not the case."

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