Long-term use of “NSAID” type pain relievers, such as aspirin and Motrin, appears to reduce the risk of oral cancer, a disease that is closely linked to tobacco use, new research suggests. Unfortunately, it may also increase the odds of dying from heart attack or stroke, so careful monitoring is required.
“When we analyzed the data, NSAID use was tied to a reduced risk of oral cancer, similar to what has been seen with colon cancer, but that didn’t translate into a survival benefit,” lead author Dr. Jon Sudbo, from The Norwegian Radium Hospital in Norway, told Reuters Health. “So, we went back and looked for an explanation and that’s when we found a doubling of the risk” of death from heart attack and stroke.
NSAIDs work by blocking so-called “COX” enzymes. In addition, to being involved in pain, these enzymes appear to play a role in oral cancer, and therefore blocking them with an NSAID might have a beneficial effect. Two previous studies have investigated this topic, but they only included aspirin use and yielded conflicting results.
The current findings, which appear in The Lancet, are based on a comparison of NSAID use between 454 heavy smokers with oral cancer and 454 similar smokers without cancer. Overall, 263 subjects had used NSAIDs for at least 6 months, 83 had used acetaminophen (Tylenol), and 562 had used neither drug.
NSAID use cut the risk of oral cancer by 53 percent, whereas use of acetaminophen, a different type of pain reliever, did not have a significant effect. Moreover, the reduction in risk tended to increase with duration of NSAID use, reaching a maximum of 70 percent for 15 or more years of use.
Consistent with previous reports, smoking cessation was also tied to a reduced risk of oral cancer, the authors note.
As noted, long-term use of NSAIDs, but not acetaminophen, raised the risk of death from heart attack or stroke by twofold.
Despite the concern over these risks, Sudbo believes that there may still be a role for NSAIDs in preventing oral cancer. “If you want to use these agents on a long-term basis (for any indication), you need to” be monitored carefully for any heart problems. He added that only patients at high risk for cancer, such as smokers, should probably be using these drugs for their cancer preventing effects.
Unfortunately, he said his team was unable to identify any factors that could predict which patients are likely to experience heart problems when using NSAIDs. Therefore, everyone who uses them on a long-term basis needs to be watched closely.
Sudbo said that his team is now planning a trial to further investigate the anti-oral cancer effect of NSAID use. If all goes well, he expects the study to be completed in 7 years.