Thinking about cancer or dealing with cancer risk can be scary or overwhelming, but we believe that receiving information and resources is comforting, empowering, and lifesaving.
Analgesics are medications used for pain relief. They include many common over-the-counter painkillers called Non-steroidal Anti-inflammatories (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin) and acetaminophen (Tylenol). Research to determine whether these medications decrease ovarian cancer risk produced conflicting results. One study showed a 25% reduction in ovarian cancer risk in women who took aspirin on a regular basis and a 50% ovarian cancer risk reduction in women who took acetaminophen on a regular basis compared to women who did not take either drug. A more recent study showed a similar risk reduction for ovarian cancer in women who took acetaminophen on a regular basis but not women who took aspirin. A third study showed no reduction in ovarian cancer risk in women who took acetaminophen. The Nurses Health Study, a large research effort following 76,821 nurses, found a risk reduction associated with NSAIDs in general but not with aspirin use. None of these studies specifically reviewed ovarian cancer risk in women with BRCA mutations. Because these studies were only observational, they do not prove taking analgesics actually lowered cancer risk.
Certain analgesics in the NSAID category may increase the risk for death from heart disease. A clinical trial studying whether Celebrex might reduce the risk for colon polyps was discontinued due to an increase in heart disease and heart-disease related deaths in people who took the medication compared to people who took a placebo. The risk was still low for death by heart disease: about 3% for people who were on the highest dose, and 2% risk for people on the lower dose. However, in that particular study, the benefits of Celebrex were not believed to outweigh the risks.
Clearly more research is needed in order to better understand analgesic use and the risk for ovarian cancer, particularly in women at high risk for ovarian cancer due to mutations in BRCA, BRIP1, RAD51C, or RAD51D. Anyone concerned about their risk for ovarian cancer should discuss the benefits, risks and limitations or risk-reducing medication with their health care team and experts in managing high-risk women.
Fenretinide is a medication related to Vitamin A. Research studies suggest Fenretinide might reduce the risk of several types of cancers. One small study looked at ovarian cancer risk in breast cancer survivors who took this medication to prevent recurrence of their breast cancer. The study found Fenretinide reduced ovarian cancer risk during the 5 years women took it, compared to women who did not take it. The risk-lowering effect did not continue when the medication was stopped. The study also suggested this protective effect against ovarian cancer may be stronger in women with BRCA mutations than women with sporadic breast cancer.
More research is needed. A clinical trial studying whether fenretinide can lower breast and ovarian cancer risk in high-risk women with BRCA mutations has been completed. Results from this research will not be available for several years.