Common pain killers linked to decreased skin cancer risk

By Laura Cowen

Use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a decreased risk for skin cancer, particularly squamous cell carcinoma (SCC) and malignant melanoma (MM), study findings indicate.

"The risk reduction was greatest among long-term and high intensity users, suggesting a cumulative and dose-dependent protective effect," write Sigrun Alba Johannesdottir (Aarhus University Hospital, Denmark) and co-authors in Cancer.

The researchers explain that NSAIDs have potential cancer-preventive effects by inhibiting cyclo-oxygenase (COX) enzymes, which are involved in carcinogenic processes such as inhibition of apoptosis, immunosuppression, and stimulation of angiogenesis.

Indeed, previous studies have shown that NSAIDs can reduce an individual's risk for developing some cancers, including colorectal cancer.

In the present study, Johannesdottir and team examined whether orally administered aspirin, other nonselective NSAIDs, or COX-2 inhibitors are associated with reduced incidence of SCC, MM, and basal cell carcinoma (BCC).

They analyzed medical records from northern Denmark from 1991 through 2009, and identified 1974 cases of SCC, 13,316 cases of BCC, and 3242 cases of MM. They compared information, including prescription data, from these patients with information from 178,655 individuals without skin cancer matched to each case by age, gender, and county of residence.

The researchers report that individuals who filled more than two prescriptions for NSAIDs (ever users) had a 15% decreased risk for developing SCC and a 13% decreased risk for developing MM compared with those who filled two or fewer prescriptions (nonusers) for the medications.

The magnitude of the associations depended on the duration and intensity of use, with long-term use (≥7 years) and high-intensity use (>25% prescription coverage during the total duration of use), particularly in combination, associated with the strongest risk reductions. Specifically, long-term, high-intensity users of any NSAIDs had a 35% reduced risk for SCC and a 46% reduced risk for MM compared with nonusers.

Ever users of NSAIDs did not have a decreased risk for developing BCC overall, but long-term and high-intensity users did have a 15% and 21% reduced risk, respectively, for developing this type of cancer on less-exposed sites (body areas other than the head and neck).

The researchers note that the risk reductions they observed were driven primarily by the use of nonselective NSAIDs and older COX-2 inhibitors (diclofenac, etodolac, and meloxicam).

"Given the high skin cancer incidence and the widespread and frequent use of NSAIDs, a preventive effect of these agents may have important public health implications," Johannesdottir and co-authors conclude.

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