Open Access Highly Accessed Research article

Analgesic and anti-inflammatory drug use and risk of bladder cancer: a population based case control study

Joan Fortuny1, Manolis Kogevinas1, Michael S Zens2, Alan Schned3, Angeline S Andrew2, John Heaney4, Karl T Kelsey5 and Margaret R Karagas2*

Author Affiliations

1 Respiratory and Environmental Health Research Unit. Municipal Institute of Medical Research (IMIM), 08003 Barcelona, Catalonia, Spain

2 Department of Community and Family Medicine, Section of Biostatistics and Epidemiology, Dartmouth Medical School, Hanover, NH 03756, USA

3 Department of Pathology, Dartmouth Medical School, Hanover, NH 03756, USA

4 Department of Surgery, Dartmouth Medical School, Hanover, NH 03756, USA

5 Departments of Community Health and Laboratory Medicine and Pathology, Brown University, PRovidence, RI 02912, USA

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BMC Urology 2007, 7:13  doi:10.1186/1471-2490-7-13

Published: 10 August 2007



Use of phenacetin and other analgesic and non-steroidal anti-inflammatory drugs (NSAIDs) potentially influences bladder cancer incidence, but epidemiologic evidence is limited.


We analyzed data from 376 incident bladder cancer cases and 463 controls from a population-based case-control study in New Hampshire on whom regular use of analgesic drugs and NSAIDs was obtained. Odds ratios and 95% confidence intervals were computed using logistic regression with adjustment for potentially confounding factors. Separate models by tumor stage, grade and TP53 status were conducted.


We found an elevated odds ratio (OR) associated with reported use of phenacetin-containing medications, especially with longer duration of use (OR >8 years = 3.00, 95% confidence interval (CI) = 1.4–6.5). In contrast, use of paracetamol did not relate overall to risk of bladder cancer. We also found that regular use of any NSAID was associated with a statistically significant decrease in bladder cancer risk (OR = 0.6, 95% CI = 0.4–0.9), and specifically use of aspirin. Further, the association with NSAID use was largely among invasive, high grade and TP53 positive tumors.


While these agents have been investigated in several studies, a number of questions remain regarding the effects of analgesic and NSAID use on risk of bladder cancer.