Nonsteroidal Anti-Inflammatory Drugs and Lung Cancer Risk: A Population-Based Case Control Study

Background:It remains unknown whether nonsteroidal anti-inflammatory drugs (NSAIDs) confer a protective effect against lung cancer development. We examined the relationship between NSAID exposure and subsequent lung cancer development in a large statewide, population-based cohort.Design:Nested case-control study in the Tennessee Medicaid population from 1990 to 2000.Methods:Lung cancer cases were identified using a statewide computerized claims database. Each time a case was identified, age- and sex-matched controls were randomly selected from the available source population. A detailed pharmacy database quantified nonsteroidal anti-inflammatory drug (NSAID) exposure during the 5 years before cancer diagnosis, and conditional logistic regression was used to examine the relationship between NSAID exposure and lung cancer development. Identical analyses were repeated in a subpopulation of high-risk individuals with chronic obstructive pulmonary disease (COPD).Results:303,399 persons were enrolled in the study population. During 1.9 million person-years of follow-up (median 6.3 years per person), 3,370 lung cancer cases were identified. Among those ever using NSAIDs, the adjusted odds ratio of developing lung cancer was 1.03 (95% confidence interval: 0.94–1.12). Among those using >24 months of NSAIDs in the 5 years before lung cancer diagnosis, the adjusted odds ratio for lung cancer was 0.96 (95% confidence interval: 0.82–1.11), and no protective effect was demonstrated in any NSAID exposure stratum. Similarly, among the 2519 high-risk individuals with chronic obstructive pulmonary disease, no significant protective effect from NSAIDs was noted.Conclusion:This large statewide, population-based study did not demonstrate a protective effect of NSAIDs on lung cancer development in either the general or high-risk chronic obstructive pulmonary disease populations.