Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) reduces the risk of mouth cancer in smokers but increases their risk of death from Heart disease, according to a Norwegian study.

The findings, published online by The Lancet, highlight the need for a careful risk-benefit analysis when long-term use of NSAIDs is considered, state the authors.

Previous studies have suggested that NSAIDs could prevent several types of cancer.

However, prolonged use of this class of drugs may cause heart problems.

Jon Sud (Norwegian Radium Hospital, Oslo, Norway) and colleagues investigated whether NSAIDs were associated with a change in the incidence of oral cancer or death from Heart disease.

The investigators identified 454 people with oral cancer from a group of 9241 heavy smokers from Norway. They selected 454 matched controls that were heavy smokers who did not have mouth cancer. 263 of the participants had used NSAIDs, 83 had used paracetamol, and 562 had used neither drug.

The researchers found that NSAIDs reduced the risk of oral cancer by 53 per cent, including in active smokers. The magnitude of the protective effect of NSAIDs against oral cancer was comparable with that of quitting smoking.

However, the investigators found that the cancer protective effect of NSAID use did not translate into increased overall survival, since long-term use of NSAIDs doubled the relative risk of death due to heart disease. 42 (16 per cent) of NSAID users died of cardiovascular events compared with 41 (7 per cent) of non-users.

“Our study suggests that NSAIDs show promise in reducing the risk of oral cancer in former and active smokers,” said Dr Sudb?.

“The magnitude of risk reduction is comparable to quitting smoking. Oral cancer prevention trials of NSAIDs are either planned or underway. Researchers of these trials must carefully monitor potential adverse cardiovascular effects in their populations, which are at an increased risk of cardiovascular disease as well as oral cancer, and implement other safety measures such as excluding patients with cardiovascular disease or specific risk factors of cardiovascular disease.

“Over the next few years, these trials will determine whether NSAIDs can reduce the devastating effect of oral cancer on patients, their families, and public health.”