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Rôle de la consommation d'Anti-inflammatoires Non Stéroïdiens (AINS) dans la survenue du cancer de la prostate, du sein, et colorectal en France

Abstract : Background – Prostate, breast, and colorectal cancers are among the most common cancers in developed countries. Many risk factors have been identified over the years but could explain only a part of the new cases. Chronic inflammation is highly suspected to play a role in the carcinogenesis of those cancers and the presence of inflammatory infiltrate in tumoral tissue, considered as precancerous lesions, reinforced this hypothesis. In this context, several epidemiological studies have investigated the potential role of Non-steroidal anti-inflammatory drugs (NSAIDs) in cancer occurrence. Indeed, NSAIDs such as aspirin and non-aspirin NSAIDS including selective inhibitors of cyclo-oxygenase 2 (COX-2) may decrease the incidence of those cancers.Objectives – The main objective of the thesis was to investigate the role of NSAIDs use including aspirin, non-aspirin NSAIDs and selective inhibitors of COX-2 in the occurrence of prostate, breast and colorectal cancers.Population and methods – This work was based on the General Sample of health insurance Beneficiaries (EGB) for the three localizations of cancer and on the data of a population-based case-control study carried out in the département of Herault (EPICAP) for prostate cancer. In the EGB study, a cohort of 426 410 persons present in the database in January 1st, 2007 allowed to identify incident cases between 2008 and 2012 based on different algorithms. Exposure to NSAIDs was determined from January 1st, 2005 until the end of the follow up defined as either cancer incident date, date of death, or censure date fixed as December 31st, 2012. A latency of at least one year between the beginning of exposure to NSAIDs and the cancer occurrence was taken into account. For the EPICAP study, 819 incident prostate cancer cases and 879 population-based controls, frequently matched by age to the cases, were face-to-face interviewed using a standardized questionnaire, specifically on their NSAIDs use.Results – From the EGB cohort, preliminary results showed a positive association between all NSAIDs use and prostate or breast cancer occurrence (RR=1,30 [1,17-1,46], RR=1,29 [1,14-1,46], respectively), while no association was found with colorectal cancer occurrence (RR=0,92 [0,82-1,05]). These associations became negative associations when a latency of six years was taken into account in prostate and colorectal cancer (RR=0,85[0,74-0,96], RR=0,77 [0,66-0,90], respectively). In the EPICAP study, NSAIDs use was negatively associated with prostate cancer (OR=0,77 [0,61-0,98]). This association was more pronounced with daily intake (OR=0,75 [0,33-0,92]) or more than once a day (OR=0,38 [0,18-0,79]), and for a duration of five to ten years (OR=0,55 [0,33-0,92]). The negative association was reinforced for preferential anti-COX-2 NSAIDs (OR=0,48 [0,28-0,79]), and for patient with high grade prostate cancer (Gleason score, GS=7 (4+3) or GS>7 : OR=0,62 [0,41-0,95]).Conclusion – This work showed that NSAIDs use was negatively to prostate and colorectal cancer occurrence. For prostate cancer, this thesis was based on two different databases (a medical and administrative database and a case-control study) and used two different methodologies, allowing comparison about strengths and limits of both.
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Submitted on : Monday, January 7, 2019 - 12:55:06 PM
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Solène Doat. Rôle de la consommation d'Anti-inflammatoires Non Stéroïdiens (AINS) dans la survenue du cancer de la prostate, du sein, et colorectal en France. Santé publique et épidémiologie. Université Paris Saclay (COmUE), 2017. Français. ⟨NNT : 2017SACLS550⟩. ⟨tel-01971812⟩



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