Racial and Ethnic Differences in the Relationship between Aspirin Use and Non–Small Cell Lung Cancer Risk and Survival

Background:African Americans (AA) experience higher incidence and mortality of lung cancer as compared with European Americans (EA). Inflammation is associated with lung cancer, many aspects of which differ between AA and EA. We investigated whether use, frequency, and duration of the anti-inflammatory drug aspirin was associated with lung cancer risk and survival, separately among AA and EA populations. Methods:Using data from the Maryland Non-Small Cell Lung Cancer (NSCLC) Case-Control Study (1,220 cases [404 AA and 816 EA] and 1,634 controls [1,004 EA and 630 AA]), we estimated the adjusted odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals (CI) of the associations between aspirin use and NSCLC risk and survival, respectively. Results:Any aspirin use (OR: 0.66, 95% CI: 0.49 - 0.89), daily use of ≥ 1 tablet (OR: 0.68, 95% CI: 0.50 - 0.90), and use for ≥ 3 years (OR: 0.61, 95% CI: 0.44 - 0.85) was associated with lower NSCLC risk only among men, even after adjustment for covariates including BMI and global genetic ancestry. These variables were also associated with improved survival, but only among AA (HR: 0.64, 95% CI: 0.46-0.91; HR: 0.61, 95% CI: 0.42 - 0.90; and HR: 0.60, 95% CI: 0.39 - 0.92, respectively). Tylenol and other NSAIDs were either associated with elevated or no NSCLC risk. Conclusions:Aspirin use is associated with lower risk of NSCLC among men and improved survival among AA. Impact: Preventive regular aspirin use could be considered among men and African Americans.