Regular Use of Aspirin or Non-Aspirin Nonsteroidal Anti-Inflammatory Drugs Is Not Associated With Risk of Incident Pancreatic Cancer in Two Large Cohort Studies

Gastroenterology. 2018 Apr;154(5):1380-1390.e5. doi: 10.1053/j.gastro.2017.12.001. Epub 2017 Dec 8.


Background & aims: Use of aspirin and/or non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) reduces the risk of several cancers, but it is not clear if use of these drugs is associated with risk of pancreatic cancer.

Methods: We evaluated aspirin and non-aspirin NSAID use and risk of pancreatic adenocarcinoma in 141,940 participants from the Health Professionals Follow-up Study and Nurses' Health Study using multivariable-adjusted Cox proportional hazards regression. We considered several exposure classifications to model differing lag times between NSAID exposure and cancer development. We also conducted a nested case-control study of participants from 3 prospective cohorts using conditional logistic regression to evaluate pre-diagnosis levels of plasma salicylurate, a major metabolite of aspirin, in 396 pancreatic cancer cases and 784 matched individuals without pancreatic cancer (controls).

Results: In the prospective cohort study, 1122 participants developed pancreatic adenocarcinoma over 4.2 million person-years. Use of aspirin or non-aspirin NSAIDs was not associated with pancreatic cancer risk, even after considering several latency exposure classifications. In a pre-planned subgroup analysis, regular aspirin use was associated with reduced pancreatic cancer risk among participants with diabetes (relative risk, 0.71; 95% CI, 0.54-0.94). In the nested case-control study, pre-diagnosis levels of salicylurate were not associated with pancreatic cancer risk (odds ratio, 1.08; 95% CI, 0.72-1.61; Ptrend 0.81; comparing participants in the highest quintile with those in the lowest quintile of plasma salicylurate).

Conclusions: Regular aspirin or non-aspirin NSAID use was not associated with future risk of pancreatic cancer in participants from several large prospective cohort studies. A possible reduction in risk for pancreatic cancer among people with diabetes who regularly use aspirin should be further examined in preclinical and human studies.

Keywords: Chemoprevention; Inflammation; NHS; Salicyluric Acid.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / chemically induced
  • Adenocarcinoma / diagnosis
  • Adenocarcinoma / epidemiology*
  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Aspirin / administration & dosage*
  • Aspirin / adverse effects
  • Case-Control Studies
  • Drug Administration Schedule
  • Female
  • Health Surveys
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nurses
  • Odds Ratio
  • Pancreatic Neoplasms / chemically induced
  • Pancreatic Neoplasms / diagnosis
  • Pancreatic Neoplasms / epidemiology*
  • Proportional Hazards Models
  • Prospective Studies
  • Protective Factors
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • United States / epidemiology


  • Anti-Inflammatory Agents, Non-Steroidal
  • Aspirin