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Cancer Epidemiol Biomarkers Prev 2008 Scheurer 1277 81

Cancer Epidemiol Biomarkers Prev 2008 Scheurer 1277 81

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Cancer Epidemiol Biomarkers Prev
Michael E. Scheurer, Randa El-Zein, Patricia A. Thompson, et al.
Use and Adult Glioma RiskLong-term Anti-inflammatory and Antihistamine Medication
Updated version
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.pubs@aacr.orgDepartment atTo order reprints of this articleor to subscribe to the journal, contact the AACR Publications
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on June 24, 2013. © 2008 American Association for Cancer Research.cebp.aacrjournals.orgDownloaded from
Short Communication
Long-term Anti-inflammatory and Antihistamine MedicationUse and Adult Glioma Risk
Michael E. Scheurer,
Randa El-Zein,
Patricia A. Thompson,
Kenneth D. Aldape,
Victor A. Levin,
Mark R. Gilbert,
 Jeffrey S. Weinberg,
and Melissa L. Bondy
Departments of 
Neuro-Oncology, and
Neurosurgery, University of Texas M. D. Anderson Cancer Center,Houston, Texas; and
Cancer Prevention and Control Program, Arizona Cancer Center, University of Arizona, Tucson, Arizona
A personal history of asthma or allergy has beenassociated with a reduced risk for adult malignantgliomas. Recent reports on the use of nonsteroidal anti-inflammatory drugs (NSAID) and the presence of riskalleles in asthma susceptibility genes showed similarinverse associations. To further explore the relationshipbetween immune mediators and gliomas, we examinedthe use of NSAID and antihistamines, history ofasthma or allergy, and infection in 325 glioma casesand 600 frequency-matched controls from the metro-politan area of Houston, TX (2001-2006). The regularuse of NSAID was associated with a 33% reduction inthe risk for glioma, suggestive of possible antitumoractivity. Surprisingly, regular long-term antihistamineuse among those reporting a history of asthma orallergies was significantly associated with a 3.5-foldincrease in the risk for glioma. Similar to previousreports, cases in our study were less likely to havereported asthma, allergy, or a history of a number ofviral infections (chickenpox or shingles, oral herpes,and mononucleosis) than controls. We therefore spec-ulate that the observed positive association withantihistamine use may reflect an alteration of protec-tive immune factors in susceptible individuals. Ourresults lend additional support for an important butunknown link between malignant brain tumors andimmune mediators.
(Cancer Epidemiol BiomarkersPrev 2008;17(5):127781)
Malignant gliomas are the most common primary braintumor in adults, yet little is known about their etiology.Epidemiologic studies suggest a lower risk for gliomasamong people reporting a history of allergies and asthma(1-10). Schwartzbaum et al. (11) reported that asthmasusceptibility gene polymorphisms in
were associated with a decreased risk for adult gliomas;however, they were unable to show significance in alarger analysis (12). Another report suggested a reducedrisk for glioma with the use of nonsteroidal anti-inflammatory drugs (NSAID; ref. 13). These studies lendsupport for a yet unexplained association betweenimmune factors and glioma risk.Antihistamines, a class of commonly used allergydrugs, have not been well examined in relation to adultgliomas. Studies on the effects of antihistamine use onthe risk for pediatric brain tumors largely pursue a directcarcinogenic action of antihistamines as nitrosatableexposures in the brain; however, results have beeninconclusive (14-17). A 2-year feeding study (NationalToxicology Program, CAS No. 147-24-0, NTP StudyTER82067) reported increased incidences of gliomas inmale Fischer 344/N rats after administration of diphen-hydramine hydrochloride, the most common antihista-mine. These drugs act to alleviate symptoms associatedwith histamine release after exposure to allergens. Wespeculated that antihistamine use would be morecommon among persons prone to allergy and morelikely to be associated with a decrease in risk, as has beenreport in previous studies (6, 7, 10). We used data from acase-control study on adult glioma in greater Houston,TX, to examine the relationships between these medi-cations and glioma risk.
Materials and Methods
Cases (
18 years) were newly diagnosed between January 2001 and January 2006 with a glioma(International Classification of Diseases for Oncology,3rd Edition, codes 9380-9481) and resided in thefollowing Texas counties: Austin, Brazoria, Chambers,Colorado, Fort Bend, Galveston, Harris, Jefferson, Liber-ty, Montgomery, Orange, San Jacinto, Walker, Waller,and Wharton. Cases were interviewed before radiother-apy or chemotherapy but typically after surgery. Proxieswere interviewed for subjects unable to participate because of disability or death. For all cases, diagnosiswas confirmed by a neuropathologist at the M. D.Anderson Cancer Center. Controls, frequency-matched
Cancer Epidemiol Biomarkers Prev 2008;17(5). May 2008
Received 9/21/07; revised 3/3/08; accepted 3/4/08.
Grant support:
National Cancer Institute grant CA 070917 (M.L. Bondy).
Current address for M.E. Scheurer: Dan L. Duncan Center, Baylor College of Medicine, Houston, Texas.
Requests for reprints:
Melissa L. Bondy, Department of Epidemiology, University of Texas M. D. Anderson Cancer Center, Unit 1340, P.O. Box 301439, Houston, TX77230-1439. Phone: 713-794-5264; Fax: 713-792-9568. E-mail: mbondy@mdanderson.orgCopyright
2008 American Association for Cancer Research.doi:10.1158/1055-9965.EPI-07-2621
on June 24, 2013. © 2008 American Association for Cancer Research.cebp.aacrjournals.orgDownloaded from
to cases by age, gender, and ethnicity, were English-speaking residents of the same Texas counties, obtainedthrough standard random-digit dialing (18, 19). Interest-ed eligible controls were contacted by study personnel toobtain consent and arrange an interview. Overallresponse rates were 77% for cases and 53% for controls.
Structured in-person or telephone inter-views using questionnaires and show cards were con-ducted with consenting cases (or proxies) and controls.Neither cases nor controls were told of the studyhypotheses during the interview. In-person interviewswere conducted for 46% of cases and 5% of controls;telephone interviews were conducted for 54% of casesand 95% of controls. Subjects answered questions aboutdemographic characteristics, personal and family medi-cal history, and occupational and environmental expo-sures. The inflammation-related questions of interestconsisted of all infectious diseases, self-report of asthmaor any allergy, and conditions associated with inflam-mation in the brain (stroke, migraine headaches, and brain injury). Information on all medications takenduring the previous 10 years was also obtained. Thetwo medications of interest for the analysis were anti-inflammatory agents (NSAID) linked with reduced riskfor other cancers and antihistamines taken for allergies,which have been shown to confer a reduced risk forgliomas. Subjects were shown or read aloud a list of thesedrugs (generic and brand names). Response rates to themedication questions among cases and controls did notdiffer significantly for in-person or telephone interviews.Cases reported similar use for in-person (15% antihist-amines, 21% NSAID) and telephone (13% antihistamines,23% NSAID) interviews. Controls reported slightlyhigher use for in-person (20% antihistamines, 44%NSAID) compared with telephone (15% antihistamines,31% NSAID) interviews; however, this was most evidentfor NSAID use. Participants were asked whether theyhad taken these drugs on a regular basis for 6 months ormore before diagnosis (cases) or time of interview(controls). If the respondent reported regular use, theinterviewer asked the specific name of the drug(s) andthe duration of regular use; dosage was not obtained.
Data Analysis.
Unconditional logistic regression wasused to estimate odds ratios and 95% confidenceintervals (95% CI). Variables that were significantlyrelated to case status in univariate analysis wereevaluated for inclusion in the final logistic model, whichwas adjusted for age, gender, and race. Referencecategories were those who reported no regular medica-tion use. Proxy-reported data did not appreciably alterour findings and were not excluded from our analysis.To be considered a confounder, the characteristics inTable 1 had to be associated with the outcome in theunexposed, associated with the exposure among thecontrols, and must have changed the point estimate bymore than 10% after adjustment. None of the variableswere found to be confounders by this method. Allanalyses were done using Stata version 8.2. All
valuesare two-sided with a 0.05 level of significance.
We obtained complete interviews from 325 cases,including 33 (4%) proxy reports, and 600 controls.
Table 1. Demographic and inflammation-related characteristics of study subjects, Harris County Adult GliomaStudy, 2001-2006
Controls (
= 600) Cases (
= 325)
value*Age (y)
Mean (SE) 50.1 (0.54) 50.6 (0.74) 0.53Gender
(%)]Male 311 (52) 188 (58) 0.08Female 289 (48) 137 (42)Race
(%)]White 476 (79) 264 (81) 0.80African-American 41 (7) 17 (5)Hispanic 71 (12) 37 (11)Other 12 (2) 7 (2)Education [
(%)]<High school 21 (4) 16 (5) 0.001High school/some college 250 (42) 173 (54)College degree 170 (28) 75 (23)Advanced degree 159 (26) 57 (18)Ever cigarette use [
(%)] 453 (76) 235 (73) 0.32Ever alcohol use [
(%)] 546 (91) 249 (77) <0.001Family history of cancer [
(%)] 468 (78) 261 (80) 0.412Family history of brain tumor [
(%)] 48 (8) 51 (16) <0.001Inflammation-related eventsHistory of asthma or allergy [
(%)] 202 (34) 44 (14) <0.001History of chickenpox [
(%)] 515 (86) 239 (74) 0.001History of shingles [
(%)] 51 (9) 17 (5) 0.069History of oral herpes [
(%)] 76 (13) 10 (3) <0.001History of mononucleosis [
(%)] 65 (11) 13 (4) 0.001History of migraine headaches [
(%)] 50 (8) 4 (1) <0.001Previous head injury [
(%)] 184 (31) 115 (36) 0.104Previous stroke [
(%)] 18 (3) 6 (2) 0.292
values derived from
tests for categorical variables and
tests for continuous variables; comparison of cases to controls.
Matching variables.
Medication Use and Glioma Risk
Cancer Epidemiol Biomarkers Prev 2008;17(5). May 2008
on June 24, 2013. © 2008 American Association for Cancer Research.cebp.aacrjournals.orgDownloaded from

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