J Clin Oncol. 2011 May 9. [Epub ahead of print]
Long-Term Use of Acetaminophen, Aspirin, and Other Nonsteroidal Anti-Inflammatory Drugs and Risk of Hematologic Malignancies: Results From the Prospective Vitamins and Lifestyle (VITAL) Study.
Walter RB, Milano F, Brasky TM, White E.
Source
Roland B. Walter, Filippo Milano, Theodore M. Brasky, and Emily White, Fred Hutchinson Cancer Research Center; Roland B. Walter, Theodore M. Brasky, and Emily White, University of Washington, Seattle, WA.
Abstract
PURPOSE Among previous studies examining the associations of over-the-counter analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) and incident hematologic malignancies, results were inconsistent for NSAIDs but suggested an increased risk with acetaminophen (paracetamol). Herein, we used a large prospective cohort study to examine these associations. PATIENTS AND METHODS In total, 64,839 men and women age 50 to 76 years were recruited from 2000 to 2002 to the Vitamins and Lifestyle (VITAL) study. Incident hematologic malignancies (n = 577) were identified through December 2008 by linkage to the Surveillance, Epidemiology and End Results cancer registry. Hazard ratios (HRs) associated with use of analgesics for total incident hematologic malignancies and cancer subcategories were estimated by Cox proportional hazards models. Models were adjusted for age, sex, race/ethnicity, education, smoking, self-rated health, arthritis, chronic musculoskeletal pain, migraines, headaches, fatigue, and family history of leukemia/lymphoma. Results After adjustment, there was an increased risk of incident hematologic malignancies associated with high use (≥ 4 days/week for ≥ 4 years) of acetaminophen (HR, 1.84; 95% CI, 1.35 to 2.50 for high use; P trend = .004). This association was seen for myeloid neoplasms (HR, 2.26; 95% CI, 1.24 to 4.12), non-Hodgkin’s lymphomas (HR, 1.81; 95% CI, 1.12 to 2.93), and plasma cell disorders (HR, 2.42; 95% CI, 1.08 to 5.41), but not chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL; HR, 0.84; 95% CI, 0.31 to 2.28). By comparison, there was no association with risk of incident hematologic malignancies for increasing use of aspirin, nonaspirin NSAIDs, or ibuprofen. CONCLUSION High use of acetaminophen was associated with an almost two-fold increased risk of incident hematologic malignancies other than CLL/SLL. Neither aspirin nor nonaspirin NSAIDs are likely useful for prevention of hematologic malignancies.
PMID: 21555699

Not all painkillers are created equal

I am not really a big fan of acetaminophen (brand name Tylenol).  For our European members, that is paracetamol.

In an earlier article on the subject of painkillers, we discussed the potential danger of irreversible liver damage as a consequence of Tylenol overdose.  Did you know Tylenol overdose is one of the most common causes of acute liver damage requiring an emergency room visit in this country?  Every one of the over-the-counter pain pills have hefty advertisement budgets, I think that is a pretty safe guess.  Johnson & Johnson is reputed to spend as much as $250 million dollars in their advertisement efforts to promote Tylenol!

The abstract below comes from the “Hutch” and University of Washington.  They studied a very large number of patients roughly in our age bracket for their use of pain-killers and the risk of blood cancers. High use of Tylenol was seen to almost double the risk of blood cancers other than CLL/NHL.   There was no similar increase in incidence of blood cancers if the patients used other non-aspirin NSAIDS, ibuprofen etc.

OK, this study says there is no increased risk of CLL/SLL incidence.  Small comfort, our guys already have CLL/SLL, that train has already left the station.  How about secondary cancers? Myeloid cancers as secondary cancer have been documented in CLL patients, especially if they have been exposed to high dose alkylating agent therapy (cyclophosphamide, chlorambucil, drug combos such as FCR etc).  The Reuters article does a good job of describing the implications of this study in plain English.

Why take a chance?  For the odd aches and pains, I think it is safer for our guys to take something else.  Personally, ibuprofen (trade name “Advil“) and naproxen sodium (”Aleve“) work just fine for me when my knee starts hurting. How about you?  What do you reach for when you hurt just a little?

J Clin Oncol. 2011 May 9. [Epub ahead of print]

Long-Term Use of Acetaminophen, Aspirin, and Other Nonsteroidal Anti-Inflammatory Drugs and Risk of Hematologic Malignancies: Results From the Prospective Vitamins and Lifestyle (VITAL) Study.

Walter RB, Milano F, Brasky TM, White E.

Fred Hutchinson Cancer Research Center; University of Washington, Seattle, WA.

PURPOSE Among previous studies examining the associations of over-the-counter analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) and incident hematologic malignancies, results were inconsistent for NSAIDs but suggested an increased risk with acetaminophen (paracetamol). Herein, we used a large prospective cohort study to examine these associations. PATIENTS AND METHODS In total, 64,839 men and women age 50 to 76 years were recruited from 2000 to 2002 to the Vitamins and Lifestyle (VITAL) study. Incident hematologic malignancies (n = 577) were identified through December 2008 by linkage to the Surveillance, Epidemiology and End Results cancer registry. Hazard ratios (HRs) associated with use of analgesics for total incident hematologic malignancies and cancer subcategories were estimated by Cox proportional hazards models. Models were adjusted for age, sex, race/ethnicity, education, smoking, self-rated health, arthritis, chronic musculoskeletal pain, migraines, headaches, fatigue, and family history of leukemia/lymphoma. Results After adjustment, there was an increased risk of incident hematologic malignancies associated with high use (≥ 4 days/week for ≥ 4 years) of acetaminophen (HR, 1.84; 95% CI, 1.35 to 2.50 for high use; P trend = .004). This association was seen for myeloid neoplasms (HR, 2.26; 95% CI, 1.24 to 4.12), non-Hodgkin’s lymphomas (HR, 1.81; 95% CI, 1.12 to 2.93), and plasma cell disorders (HR, 2.42; 95% CI, 1.08 to 5.41), but not chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL; HR, 0.84; 95% CI, 0.31 to 2.28). By comparison, there was no association with risk of incident hematologic malignancies for increasing use of aspirin, nonaspirin NSAIDs, or ibuprofen. CONCLUSION High use of acetaminophen was associated with an almost two-fold increased risk of incident hematologic malignancies other than CLL/SLL. Neither aspirin nor nonaspirin NSAIDs are likely useful for prevention of hematologic malignancies.

PMID: 21555699