It was an interesting study led by Drs Preston, Shore and Wilson that looked at the effect of analgesics, so acetaminophen, aspirin and non-aspirin NSAIDs and all of us, many of us, take these medications for pain, fever and others. Looking specifically at two cohorts. The interesting thing about the cohorts, the follow-up is more than twenty years and those cohorts involve more than 100,000 patients, women and men, the Nurses’ Health Study and the Physician Health Professional Follow-Up Study.  In fact our group reported in the past about the relationship between renal cell cancer and not acetaminophen or aspirin but an increased risk with non-aspirin NSAIDs in this prospective longitudinal study. Looking again at these two studies we confirmed that risk with non-aspirin NSAIDs but what is important we looked at clear cell versus all RCC, it is confirmed, and we looked also at the lethal form of renal cell because there are some renal cells that actually do not lead to killing the patient, of course. So we looked at the lethal form, those renal cell carcinomas that led to the patient dying from kidney cancer. Again, non-aspirin NSAIDs increased the risk of having a renal cell cancer, a lethal form of renal cell cancer.
More interesting, we have data from these two wonderful cohorts about the amount or the number of years that non-aspirin NSAIDs were consumed. With higher consumption there is even higher risk, so a cumulative effect. This is very interesting data, the next step is we’re getting these samples, over 400 cases, to see if there is anything genomically or anything in the pathway that can explain why these patients and what they have and what their exposure to NSAID can do to these patients, especially that this is one of the most consumed over the counter medications.
Do you have an idea of the cause?
Hard to guess. We looked at this specifically – is it the passage in the kidneys, is that an effect there on the tubules and is there any effect in the initiation of cancer at that level? Is it a direct effect or is it a local effect? What pathways are affected and is there something that predisposes the patient? We do not have a clear explanation for this yet. I cannot say that these non-aspirin NSAIDs, ‘Yes, they’re carcinogenic,’ no, they are not considered carcinogenic. So that could be something. The other question is who is the person that is at higher, much higher, risk if they’re exposed to these drugs for a long period that will have potentially the lethal form of RCC. This will be the subject of further studies with our group.
What is your take home message so far?
The take home message is there is more and more evidence that non-aspirin NSAIDs, unlike acetaminophen, may raise your risk. The risk still is very small but it’s statistically significant, but it raises your risk of developing kidney cancer, especially the lethal form but with more prolonged use rather than intermittent or used for a short period of time.