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Aspirin intake and breast cancer survival – a nation-wide study using prospectively recorded data in Sweden

Michelle D Holmes12*, Henrik Olsson3, Yudi Pawitan3, Johanna Holm3, Cecilia Lundholm3, Therese M-L Andersson3, Hans-Olov Adami23, Johan Askling4 and Karin Ekström Smedby4

Author Affiliations

1 Channing Division of Network Medicine, 181 Longwood Ave, Boston, MA 02115, US

2 Department of Epidemiology, Harvard School of Public Health, Boston, MA, US

3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

4 Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden

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BMC Cancer 2014, 14:391  doi:10.1186/1471-2407-14-391

Published: 2 June 2014



Aspirin (ASA) use has been associated with improved breast cancer survival in several prospective studies.


We conducted a nested case–control study of ASA use after a breast cancer diagnosis among women using Swedish National Registries. We assessed prospectively recorded ASA exposure during several different time windows following cancer diagnosis using conditional logistic regression with breast cancer death as the main outcome. Within each six-month period of follow-up, we categorized dispensed ASA doses into three groups: 0, less than 1, and 1 or more daily doses.


We included 27,426 women diagnosed with breast cancer between 2005 and 2009; 1,661 died of breast cancer when followed until Dec 31, 2010. There was no association between ASA use and breast cancer death when exposure was assessed either shortly after diagnosis, or 3–12 months before the end of follow-up. Only during the period 0–6 months before the end of follow-up was ASA use at least daily compared with non-use associated with a decreased risk of breast cancer death: HR (95% CI) = 0.69 (0.56-0.86). However, in the same time-frame, those using ASA less than daily had an increased risk of breast cancer death: HR (95% CI) = 1.43 (1.09-1.87).


Contrary to other studies, we did not find that ASA use was associated with a lower risk of death from breast cancer, except when assessed short term with no delay to death/end of follow-up, which may reflect discontinuation of ASA during terminal illness.

Aspirin; Breast neoplasms; Survival; Prospective study; Sweden; Registries