Effect of Chronic Intake of NSAIDs and Cyclooxygenase 2-Selective Inhibitors on Esophageal Cancer Incidence

Background & Aims: A rising incidence and a poor survival rate make esophageal cancer a major health issue, hence the need for chemoprevention. We investigated the effects of the selective cyclooxygenase 2 inhibitors (coxibs), rofecoxib and celecoxib, the nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), and aspirin on esophageal cancer. Methods: This nested case-control study used data from a government-run insurance database on patients 66 years and older who underwent esophageal imaging (esophagogastroduodenoscopy or barium swallow) between January 1999 and September 2002. Logistic regression models were used to determine the effect of chronic exposure, by using as proxy at least 30 days of use of the drugs of interest in the past year, on the occurrence of esophageal cancer. Results: The study included 251 cases and all 86,644 eligible control subjects. Patients more likely to have esophageal cancer (odds ratio, 95% confidence interval) were men (3.42, 2.62-4.48) and older subjects (those 75-84 years and those >= 85 years: 1.40, 1.08-1.82 and 1.69, 1.05-2.72, respectively). Chronic exposure to coxibs or NSAIDs was associated with a significant risk reduction for esophageal cancer (0.63, 0.40-0.98 and 0.47, 0.24-0.93, respectively). Assessed separately, the point estimates were slightly lower for rofecoxib than for celecoxib when examining a possible duration-response effect, although all 95% confidence intervals overlapped (celecoxib: 0.51, 0.27-0.98; 0.30, 0.11-0.82; 0.39, 0.14-1.05; rofecoxib: 0.39, 0.16-0.96; 0.37, 0.12-1.16; 0.33, 0.08-1.36 for exposures of >= 30, >= 60, and >= 90 days, respectively). Conclusions: Chronic intake of rofecoxib and celecoxib and of nonselective NSAIDs appears to be associated with a decreased incidence of esophageal cancer.