PDF(Pubmed)
Abstract：
Low-dose aspirin has been hypothesized to prevent cancer risk by inhibiting platelet aggregation. However, the anti-cancer effect of low-dose aspirin has recently been questioned and its effect on breast cancer development remains unclear. The impact of other antiplatelet drugs on breast cancer risk has rarely been evaluated. Thus, this study aimed to investigate the associations between breast cancer risk and antiplatelet drug use in a nationwide nested case-control study. From the Danish healthcare registries, we identified as cases all women with invasive breast cancer diagnosis between 2001 and 2018 (n = 68 852). The date of diagnosis corresponded to the index date. We matched cases to 10 population controls on age and calendar time, using risk set sampling. Controls were assigned the same index date as their matched case. We used the prescription registry to identify exposure to low-dose aspirin, clopidogrel and dipyridamole. We defined ever use of antiplatelet drugs as at least two prescriptions filled up to 1 year before the index date. We applied conditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals for breast cancer associated with the use of antiplatelet drugs, overall, by breast cancer subtype and by cumulative dose. Twelve percent of women had ever been exposed to low-dose aspirin, 2% to clopidogrel and 2% to dipyridamole. In multivariable models, breast cancer risk was not associated with ever use of low-dose aspirin (OR = 1.00 [0.97-1.03]), clopidogrel (OR = 0.93 [0.87-1.00]), and dipyridamole (OR = 1.02 [0.94-1.10]), compared with never use, and there was no evidence of a dose-response relation. However, we found an inverse association between dipyridamole use and breast cancer risk among women aged <55 years old, with suggestion of a dose-response relationship (OR per 1000 Defined Daily Doses = 0.72 [0.54-0.95]). Associations did not differ by breast cancer histological type, estrogen receptor status or clinical stage at diagnosis. Overall, the findings from this study do not support the use of antiplatelet drugs for breast cancer prevention.
摘要：
据推测，低剂量阿司匹林可以通过抑制血小板聚集来预防癌症风险。然而,低剂量阿司匹林的抗癌作用最近受到质疑,其对乳腺癌发展的影响仍不清楚.很少评估其他抗血小板药物对乳腺癌风险的影响。因此，本研究旨在调查一项全国性巢式病例对照研究中乳腺癌风险与抗血小板药物使用之间的关联.来自丹麦的医疗登记处，我们确定了2001年至2018年诊断为浸润性乳腺癌的所有女性为病例(n=68852).诊断日期对应于索引日期。我们在年龄和日历时间上将病例与10个人口对照进行了匹配，使用风险集抽样。为对照分配了与其匹配案例相同的索引日期。我们使用处方注册来确定低剂量阿司匹林的暴露，氯吡格雷和潘生丁.我们将曾经使用抗血小板药物定义为在索引日期前1年内至少使用两种处方。我们应用条件逻辑回归来计算与使用抗血小板药物相关的乳腺癌的比值比(OR)和95%置信区间。总的来说,按乳腺癌亚型和累积剂量。12%的女性曾经接触过低剂量的阿司匹林，2%对氯吡格雷和2%对双嘧达莫。在多变量模型中，乳腺癌风险与使用低剂量阿司匹林无关（OR=1.00[0.97-1.03]），氯吡格雷（OR=0.93[0.87-1.00]），和双嘧达莫（OR=1.02[0.94-1.10]），与从不使用相比，并且没有剂量反应关系的证据。然而,我们发现，在年龄<55岁的女性中，使用潘生丁与乳腺癌风险呈负相关，建议剂量-反应关系（OR每1000个定义的每日剂量=0.72[0.54-0.95]）。乳腺癌组织学类型的关联没有差异，诊断时的雌激素受体状态或临床阶段。总的来说,本研究结果不支持使用抗血小板药物预防乳腺癌.
