The Association between Over-the-Counter Analgesic Use and Renal Cell Carcinoma
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Background: Previous epidemiologic studies have found some evidence of an association between over-the-counter (OTC) analgesic use and renal cell carcinoma (RCC). Animal studies have shown analgesics causing certain lesions and adenomas in the kidneys. Most epidemiologic studies looked at prescription analgesic use had inconsistent findings. Overall, the current literature contains certain gaps in understanding the association between OTC analgesic use and RCC. Purpose: This study aimed to examine the relationship between OTC analgesic use and RCC. The study also investigated potential modifying effects of BMI, physical activity, alcohol and coffee consumption and smoking on the association between analgesic use and RCC. Methods: We used a frequency-matched case-control study conducted at Roswell Park Cancer Institute in Buffalo, NY. A total of 606 participants were used, of which 202 had physician-diagnosed, histology-confirmed renal cell-carcinoma. All participants filled out a questionnaire with 1,100 items. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for incident RCC by dichotomous OTC analgesic use (regular/non-regular). Additional models were analyzed adjusting for potential confounders (age, race/ethnicity, BMI, smoking, alcohol consumption, caffeine intake, and physical activity). Potential modifying effects were assessed by investigating multiplicative interaction between OTC analgesic use and physical activity, BMI, smoking, coffee and alcohol consumption and smoking on their association with RCC. Results: There were no statistically significant findings for the main effect between over-the-counter analgesic use and RCC. Significant multiplicative interactions were found for BMI with an OR for interaction=0.30, 95% CI: 0.13, 0.70. Specifically individuals with any analgesic use were found to have differential odds of RCC based on high BMI (≥30) vs. normal BMI. Those with a normal BMI (18.5-24.9) and any analgesic use had an OR(95%CI) of 2.76 (1.29, 5.90), and those with a high BMI and any analgesic use had an OR(95%CI) of 1.94 (1.08, 3.43). Caffeine consumption and BMI both showed evidence of effect modification in the stratified analyses. Conclusions: We did not find an association between OTC analgesic use and RCC. However, this was one of the first studies to investigate interaction with BMI and physical activity on this relationship. The results with BMI and analgesic use show a potential ability to better metabolize these medications based on higher BMI status. Our exposure assessment lacked dose of analgesics, this may potentially lead to our null findings and previous studies have found the largest differences among varying levels of dose. Furthermore, our sample size was relatively small compared to other studies, which found small effect sizes for this relationship. More studies need to investigate potential interaction with BMI and physical activity on a larger scale.