How can non-aspirin NSAIDs help you? What the research says

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation, with notable benefits in increasing survival and reducing risk of several types of cancer; however, expert consensus is that the risks of harm from using these drugs long-term are greater than the benefits for prevention against cancer for many people.

How can non-aspirin NSAIDs help you? What the research says

We summarize the clinical evidence for each medical benefit here. We begin with our assessment of the strength of evidence within each category, followed by a brief summary of individual studies or reviews of several studies. In assessing the strength of evidence, we consider the study design, number of participants, and the size of the treatment effect (how much outcomes changed with treatment).

To see more details, click the plus sign to the right of any section.

Our assessments of evidence for each medical benefit fall into one of these categories:

Strong evidence: consistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analysesa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results
Good evidence: significant effects in one large or several mid-sized and well-designed clinical studies ( randomized controlled trialsa study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects with an appropriate placebo or other strong comparison control or observational studies that control for confounds)
Modest evidence: significant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies), or several small studies aggregated into a meta-analysis
Preliminary evidence: significant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect
Weak evidence: one or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects
Insufficient evidence: preclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example)

Learn more about how we research and rate therapies and practices in How We Rate Therapies ›

Preclinical evidencetesting a drug, a procedure, or another medical treatment in isolated cells or in animals; preclinical evidence is considered only an initial indication of possible effects in people is summarized in Are you a health professional? ›

COX inhibitors

You’ll see throughout this page mentions of COX-2 inhibitors and selective or non-selective COX inhibitors.

COX-2 (cyclooxygenase-2) is an enzyme responsible for inflammation and pain. COX-1 is a similar enzyme that also contributes to inflammation and pain, but in addition produces substances that activate platelets and protect the stomach and intestinal lining. COX-1 also helps maintain kidney blood flow and filtration.¹Ogbru A. COX-2 Inhibitor Medications. RX List. April 8, 2021. Viewed September 29, 2021. Any drugs that inhibit COX-1 also increase the risk of bleeding or problems with your stomach and kidneys.

COX-2 inhibitors were developed to target inflammation and pain, but with lower risk of bleeding, stomach, and kidney problems. NSAIDs that directly and selectively target COX-2 are classified as COX-2 selective inhibitors. Celecoxib is an example. Non-selective COX inhibitors, such as ibuprofen, inhibit both COX-1 and COX-2.²Dyall-Smith D. Non-steroidal anti-inflammatory drugs and their skin side effects. DermNet NZ. Viewed January 28, 2021.

Improving treatment outcomes

Are non-aspirin NSAIDs linked to improved survival? Are they linked to less cancer growth or metastasis? Do they enhance the anticancer action of other treatments or therapies? We present the evidence.

See preclinical evidencetesting a drug, a procedure, or another medical treatment in isolated cells or in animals; preclinical evidence is considered only an initial indication of possible effects in people of synergistic effects with conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocialtherapy, and acupuncture therapies in Are you a health professional? ›

Advanced cancer

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) for specific patients: people in palliative care who had certain genetic factors saw slower progression while taking celecoxib

Cancer as a whole

Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently): As a whole, people taking NSAIDs along with standard cancer treatment did not show better survival. However, there was preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of better survival among people who received NSAIDs at the time of cancer surgery and people with cancer-related malnutrition who received indomethacin.

No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on overall survival or progression among people with cancer taking NSAIDS along with standard treatment in a combined analysis of 20 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁴Benjamin DJ, Haslam A, Prasad V. Cardiovascular/anti-inflammatory drugs repurposed for treating or preventing cancer: A systematic review and meta-analysis of randomized trials. Cancer Medicine. 2024 Mar;13(5):e7049.
Longer disease-free survival among people with cancer who received NSAIDs either shortly before, during, or shortly after surgery, with longer overall survival among people who received ketorolac as opposed to other NSAIDs, in a combined analysis of 16 retrospective studies⁵Shaji S, Smith C, Forget P. Perioperative NSAIDs and long-term outcomes after cancer surgery: a systematic review and meta-analysis. Current Oncology Reports. 2021 Nov 8;23(12):146.
Substantially greater survival among people with cancer-related malnutrition treated with indomethacin compared to placeboa pill, medicine, or procedure—thought to be both harmless and ineffective—prescribed for the psychological benefit to the patient or as a sham treatment in a study to allow a comparison to a therapy of interest in a mid-sized RCT⁶Lundholm K, Gelin J et al. Anti-inflammatory treatment may prolong survival in undernourished patients with metastatic solid tumors. Cancer Research. 1994 Nov 1;54(21):5602-6.
No evidence of an effect on progression-free (5 studies) or overall survival (6 studies) among people with cancer treated with NSAIDS in addition to immune checkpoint inhibitors in meta-analysesstatistical analyses that combine the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies⁷Zhang Y, Chen H et al. The effect of concomitant use of statins, NSAIDs, low-dose aspirin, metformin and beta-blockers on outcomes in patients receiving immune checkpoint inhibitors: a systematic review and meta-analysis. Oncoimmunology. 2021 Aug 2;10(1).

Breast cancer

Celecoxib

No evidence: people with postmenopausal breast cancer treated with celecoxib showed no evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. in two studies

Ketorolac

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently): people with breast cancer treated with ketorolac around the time of surgery showed better survival in two studies

Celecoxib

No evidence of an effect on all-cause mortalitydeath, or the death rate in a population; cancer studies often report all-cause mortality (death from any cause) and cancer-specific mortality (death due to the cancer under investigation) or event-free survival among people with postmenopausal hormone receptor-positive breast cancer treated with celecoxib for 18 months compared to placeboa pill, medicine, or procedure—thought to be both harmless and ineffective—prescribed for the psychological benefit to the patient or as a sham treatment in a study to allow a comparison to a therapy of interest in a large RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁸Strasser-Weippl K, Higgins MJ et al. Effects of celecoxib and low-dose aspirin on outcomes in adjuvant aromatase inhibitor-treated patients: CCTG MA.27. Journal of the National Cancer Institute. 2018 Sep 1;110(9):1003-1008.
No evidence of an effect on proliferation or apoptosis among postmenopausal women with ER-positive ductal carcinoma in situ (DCIS) treated either with celecoxib alone or in combination with exemestane in a small RCT⁹Bundred NJ, Cramer A et al. Cyclooxygenase-2 inhibition does not improve the reduction in ductal carcinoma in situ proliferation with aromatase inhibitor therapy: results of the ERISAC randomized placebo-controlled trial. Clinical Cancer Research. 2010 Mar 1;16(5):1605-12.

Ketorolac

Better overall survival among people treated with ketorolac around the time of breast cancer surgery in a mid-sized observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study¹⁰Forget P, Bentin C et al. Intraoperative use of ketorolac or diclofenac is associated with improved disease-free survival and overall survival in conservative breast cancer surgery. British Journal of Anaesthesia. 2014 Jul;113 Suppl 1:i82-7.

Colorectal cancer

NSAIDs as a whole

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) for specific patients: people with colorectal cancer and no KRAS mutation treated with any NSAID showed better survival.

Celecoxib

Modest evidence: people with colorectal cancer taking celecoxib alongside chemotherapy saw better survival and a higher rate of response to treatment across several studies, though not all studies have found this effect.

NSAIDs as a whole

40% lower risk of overall mortality among people with colorectal cancer with KRAS wild-type tumors, but not among those with KRAS-mutant tumors, with use of any NSAID after diagnosis compared to no use in a large observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study¹¹Hua X, Phipps AI et al. Timing of aspirin and other nonsteroidal anti-inflammatory drug use among patients with colorectal cancer in relation to tumor markers and survival. Journal of Clinical Oncology. 2017 Aug 20;35(24):2806-2813.

Celecoxib

Better overall survival among people taking celecoxib at any dose following treatment for colorectal cancer, and a higher rate of response to treatment among those taking 400mg, though no evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on rates of remission in a combined analysis of 9 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects¹²Hu T, Liu CJ et al. Selective COX-2 inhibitors do not increase gastrointestinal reactions after colorectal cancer surgery: a systematic review and meta-analysis. BMC Gastroenterology. 2023 Aug 14;23(1):281.
No evidence of improved response to treatment among people with metastatic adenocarcinoma of the colon or rectum among people treated with a combination of intravenous irinotecan, oral capecitabine in 21-day cycles, and celecoxib at a daily dose of 800 mg for the duration of the study in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design¹³El-Rayes BF, Zalupski MM et al. Phase-II study of dose attenuated schedule of irinotecan, capecitabine, and celecoxib in advanced colorectal cancer. Cancer Chemotherapy and Pharmacology. 2008 Feb;61(2):283-9.
No evidence of improved response to treatment among people with previously untreated metastatic colorectal cancer treated with weekly irinotecan, 5-fluorouracil, and leucovorin for 4 weeks every 6 weeks and oral celecoxib with in a small uncontrolled trial¹⁴Chen EY, Blanke CD et al. A phase II study of celecoxib with irinotecan, 5-fluorouracil, and leucovorin in patients with previously untreated advanced or metastatic colorectal cancer. American Journal of Clinical Oncology. 2018 Dec;41(12):1193-1198.

Gastrointestinal cancer

Colorectal cancer is listed separately.

Preliminary evidence for specific patients: People with positive COX-2 expression and metastatic or postoperative recurrent stomach cancer who took celecoxib alongside chemotherapy had better survival and slower progression in one study.

Head and neck cancer

Preliminary evidence for specific patients: People with head and neck cancer who had PIK3CA gene mutations or amplification and who took celecoxib or sundilac had smaller tumor volume in one study.

Kidney cancer

Preliminary evidence: People with kidney cancer who were treated with ketorolac around the time of surgery had better survival in one study.

Lung cancer

Celecoxib

Modest evidence: People with advanced non-small cell lung cancer who took celecoxib showed a better response rate to chemotherapy and better short-term survival, but only some evidence of long-term survival, across several studies.

Diclofenac

Preliminary evidence: People with lung cancer treated with diclofenac around the time of surgery showed better survival in one study.

Celecoxib

Better response to first-line cancer treatment but no evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on 5-year overall or progression-free survivalthe time during and after treatment of a disease that a patient lives without disease progression (worsening) among people with advanced non-small cell lung cancer treated with celecoxib compared to placeboa pill, medicine, or procedure—thought to be both harmless and ineffective—prescribed for the psychological benefit to the patient or as a sham treatment in a study to allow a comparison to a therapy of interest in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 7 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects¹⁸Yi L, Zhang W et al. Systematic review and meta-analysis of the benefit of celecoxib in treating advanced non-small-cell lung cancer. Drug Design, Development and Therapy. 2018 Aug 7;12:2455-2466.
Better overall response rate, but no evidence of an effect on 1-year survival, clinical benefit, complete response or partial response among people with advanced non‐small cell lung cancer treated with chemotherapy and celecoxib compared to chemotherapy alone, but with increased risk of blood-related toxicities (leukopenia or thrombocytopeniaan abnormally low number of platelets in the blood, which may cause easy bruising and excessive bleeding from wounds or bleeding in mucous membranes and other tissues) in a meta-analysis of 6 RCTs¹⁹Hou LC, Huang F, Xu HB. Does celecoxib improve the efficacy of chemotherapy for advanced non-small cell lung cancer? British Journal of Clinical Pharmacology. 2016 Jan;81(1):23-32.
Better overall response rate, 12-month survival, and 6- and 12-month progression-free survival—but not 6-month survival—among people with advanced non‐small cell lung cancer treated with chemotherapy and celecoxib compared to chemotherapy alone, but with increased risk of toxicities (leukopenia, thrombocytopenia, cardiovascular events, and diarrhea) in meta-analyses of 8‒13 RCTs²⁰Zhang W, Yi L et al. Comparison of the benefits of celecoxib combined with anticancer therapy in advanced non-small cell lung cancer: a meta-analysis. Journal of Cancer. 2020 Jan 20;11(7):1816-1827.
Better overall response rate and a weak trend toward better 12-month overall survival, plus better progression-free survival at 6 and 12 months, among people with advanced non‐small cell lung cancer treated with tyrosine kinase inhibitors and celecoxib compared to tyrosine kinase inhibitors alone in meta-analyses of 3‒5 RCTs²¹Zhang W, Yi L et al. Comparison of the benefits of celecoxib combined with anticancer therapy in advanced non-small cell lung cancer: a meta-analysis. Journal of Cancer. 2020 Jan 20;11(7):1816-1827.
No evidence of an effect on 1-year overall survival among people with advanced non‐small cell lung cancer treated with radiotherapy and celecoxib compared to radiotherapy alone in a small RCT²²Zhang W, Yi L et al. Comparison of the benefits of celecoxib combined with anticancer therapy in advanced non-small cell lung cancer: a meta-analysis. Journal of Cancer. 2020 Jan 20;11(7):1816-1827.
These studies also found that celecoxib could increase the risk of serious side effects from chemotherapy; see Safety and Precautions >

Diclofenac

Better survival among people with lung cancer treated with diclofenac use around the time of surgery compared to no diclofenac in a mid-sized observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study²³Forget P, Machiels JP et al. Neutrophil:lymphocyte ratio and intraoperative use of ketorolac or diclofenac are prognostic factors in different cohorts of patients undergoing breast, lung, and kidney cancer surgery. Annals of Surgical Oncology. 2013 Dec;20 Suppl 3:S650-60.

Ovarian cancer

Weak (conflicting) evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently): People with ovarian cancer taking non-aspirin NSAIDs after diagnosis showed lower mortality in two studies, but no effect on overall survival in a combined analysis of studies. In one small study, people taking celecoxib alongside carboplatin chemotherapy may have shown an improved response to treatment (weak evidence).

No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on overall survival among people with ovarian cancer treated with NSAIDs in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies²⁴Majidi A, Na R, Dixon-Suen S, Jordan SJ, Webb PM. Common medications and survival in women with ovarian cancer: a systematic review and meta-analysis. Gynecological Oncology. 2020 Jun;157(3):678-685.
33% lower cancer-specific mortality among people with invasive, stage1–3 epithelial ovarian cancer with recent and regular non-aspirin NSAID use after diagnosis compared to never users, but no evidence of an effect of use before diagnosis in a large observational study²⁵Merritt MA, Rice MS et al. Pre-diagnosis and post-diagnosis use of common analgesics and ovarian cancer prognosis (NHS/NHSII): a cohort study. Lancet Oncology. 2018 Aug;19(8):1107-1116.
14–25% lower cancer-specific mortality among women with serous ovarian cancer but not other cancer subtypes with higher cumulative doses of non-aspirin NSAIDs after diagnosis compared to never users—but no evidence of an effect with infrequent users—in a large observational study;²⁶Verdoodt F, Dehlendorff C, Friis S, Kjaer SK. Non-aspirin NSAID use and ovarian cancer mortality. Gynecologic Oncology. 2018 Aug;150(2):331-337. also see evidence of higher mortality among people with non-serous ovarian tumors with NSAID use in Safety and precautions ›
Possibly increased sensitivity to carboplatin among heavily-treated people with recurrent ovarian cancer treated with celecoxib in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design²⁷Legge F, Paglia A et al. Phase II study of the combination carboplatin plus celecoxib in heavily pre-treated recurrent ovarian cancer patients. BMC Cancer. 2011 May 31;11:214.

Sarcoma

Weak evidence: People with Desmoid and inflammatory myofibroblastic sarcomas treated with diclofenac showed better response to treatment in case studies.

NSAIDs combined with other therapies

Weak evidence: One person with inoperable pancreatic cancer taking a combination treatment of diclofenac plus gemcitabine, cimetidine, low-dose cyclophosphamide, and sulfasalazine showed a better response to treatment in a single case study.

Optimizing your body terrain

Do non-aspirin NSAIDs promote an environment within your body that is less supportive of cancer development, growth, or spread? We present the evidence.

See Optimizing Your Body Terrain ›

Find medical professionals who specialize in managing body terrain factors: Finding Integrative Oncologists and Other Practitioners ›

We also recommend that you share with your doctor the information here about how non-aspirin NSAIDs might affect these terrain factors if you have any imbalances.

Blood sugar and insulin resistance

Inflammation

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently): Because NSAIDs are widely recognized as having anti-inflammatory effects, few studies set out to test their anti-inflammatory effects in people with cancer specifically. People with cancer-related cachexia who took long-term indomethacin did show less inflammation in one study.

NSAIDs combined with other therapies

Managing side effects and promoting wellness

Are non-aspirin NSAIDs linked to fewer or less severe side effects or symptoms? Are they linked to less toxicity from cancer treatment? Do they support your quality of life or promote general well-being? We present the evidence.

Side effects as a whole

No evidenceoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments.: NSAIDs have not been widely studied for their effects on cancer treatment side effects overall. People with advanced hormone-sensitive breast cancer who took celexocib in addition to exemestane showed no evidence of a difference in side effects in one study.

Anxiety

No evidence: People with advanced or recurrent stomach cancer taking celecoxib alongside chemotherapy showed no difference in anxiety.

Blood-related symptoms

No evidence: People with stomach cancer taking celecoxib during chemotherapy did not show a difference in neutropenia (low count of neutrophils, a type of white blood cell that protects against infection).

Body composition and cachexia

Celecoxib

Insufficient (conflicting) evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently): People with stomach cancer who took celecoxib alongside chemotherapy showed no effect on cachexia (cancer-related wasting) in one study, but people awaiting treatment for different types of cancer who took showed increased body weight in another study.

Ibuprofen

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently): People with advanced gastrointestinal cancer and cancer-related weight loss who took ibuprofen in addition to megestrol acetate showed more weight gain in one study.

Indomethacin

Preliminary evidence: People with cancer-related weight loss who took indomethacin showed greater body weight in one study (though they still experienced muscle wasting) and less energy expenditure in another.

Bone and joint symptoms

Preliminary evidence: People with hormone-sensitive breast cancer taking celecoxib showed better bone mineral density during exemastane treatment in one study.

Changes in appetite

Celecoxib

No evidence: People with stomach cancer taking celecoxib showed no evidence of an effect on chemotherapy-induced loss of appetite in one study.

Ibuprofen

Preliminary evidence: People with advanced gastrointestinal cancer taking ibuprofen in addition to megestrol acetate (MA) showed better appetite in one study.

Depression

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently): People without cancer but with major depressive disorder (MDD) taking NSAIDs showed improved depression symptoms across several studies.

Fatigue

No evidence: People undergoing chemotherapy for stomach cancer taking celecoxibshowed no evidence of an effect on fatigue in one study.

Gastrointestinal symptoms, including nausea and vomiting

No evidence: People taking celecoxib during chemotherapy for stomach cancer showed no effect on vomiting or diarrhea in one study.

Neurological symptoms

No evidence: People with stomach cancer taking celecoxib during chemotherapy showed no effect on peripheral neuropathy in one study.

Oral symptoms

No evidence: People with stomach cancer taking celecoxib during chemotherapy showed no evidence of an effect on dry mouth in one study.

Pain

Diclofenac

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently): People with different types of cancer taking diclofenac showed less persistent cancer pain across several studies.

Ibuprofen

No evidence: People with different types of cancer treated with ibuprofen showed no evidence of an effect on persistent cancer pain intensity across several studies.

Indomethacin

Preliminary evidence: People with cancer-related malnutrition taking indomethacin showed less pain in one study, see details below for safety concerns

Ketorolac tromethamine

No evidence: People with different types of cancer taking ketorolac tromethamine showed no evidence of an effect on persistent cancer pain intensity across several studies.

Naproxen

No evidence: People with different types of cancer taking naproxen showed no evidence of an effect on persistent cancer pain intensity across several studies.

Sulindac

No evidence: People with different types of cancer taking sundilac showed no evidence of an effect on persistent cancer pain intensity across several studies.

The main use of NSAIDs is to reduce fever and inflammation, which is often accompanied by pain.⁵²Nonsteroidal Anti-inflammatory Drugs (NSAIDs). US Food and Drug Administration. December 9, 2020. Viewed February 9, 2021. Because NSAIDs are so effective in reducing pain from inflammation, they are some of the most commonly used medications.⁵³Bindu S, Mazumder S, Bandyopadhyay U. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: a current perspective. Biochemical Pharmacology. 2020 Oct;180:114147. We present findings specific to cancer pain.

Diclofenac

Less persistent (chronic) cancer pain among people treated with diclofenac compared to placeboa pill, medicine, or procedure—thought to be both harmless and ineffective—prescribed for the psychological benefit to the patient or as a sham treatment in a study to allow a comparison to a therapy of interest in a combined analysis of 18 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁵⁴Huang R, Jiang L et al. Comparative efficacy of therapeutics for chronic cancer pain: a Bayesian network meta-analysis. Journal of Clinical Oncology. 2019 Jul 10;37(20):1742-1752.

Ibuprofen

No evidence of an effect on persistent (chronic) cancer pain intensity among people treated with ibuprofen compared to placebo in a large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 18 RCTs⁵⁵Huang R, Jiang L et al. Comparative efficacy of therapeutics for chronic cancer pain: a Bayesian network meta-analysis. Journal of Clinical Oncology. 2019 Jul 10;37(20):1742-1752.

Indomethacin

Less pain and less analgesic use among people with insidious or overt malnutrition due to generalized malignancy treated with indomethacin in a mid-sized RCT⁵⁶Lundholm K, Gelin J et al. Anti-inflammatory treatment may prolong survival in undernourished patients with metastatic solid tumors. Cancer Research. 1994 Nov 1;54(21):5602-6.
See evidence of worse persistent cancer pain in Safety and precautions ›

Ketorolac tromethamine

No evidence of an effect on persistent (chronic) cancer pain intensity among people treated with ketorolac tromethamine compared to placebo in a large meta-analysis of 18 RCTs⁵⁷Huang R, Jiang L et al. Comparative efficacy of therapeutics for chronic cancer pain: a Bayesian network meta-analysis. Journal of Clinical Oncology. 2019 Jul 10;37(20):1742-1752.

Naproxen

No evidence of an effect on persistent (chronic) cancer pain intensity among people treated with naproxen compared to placebo in a large meta-analysis of 18 RCTs⁵⁸Huang R, Jiang L et al. Comparative efficacy of therapeutics for chronic cancer pain: a Bayesian network meta-analysis. Journal of Clinical Oncology. 2019 Jul 10;37(20):1742-1752.

Sulindac

No evidence of an effect on persistent (chronic) cancer pain intensity among people treated with sulindac compared to placebo in a large meta-analysis of 18 RCTs⁵⁹Huang R, Jiang L et al. Comparative efficacy of therapeutics for chronic cancer pain: a Bayesian network meta-analysis. Journal of Clinical Oncology. 2019 Jul 10;37(20):1742-1752.

Also see evidence of worse pain scores among people with metastatic or postoperative recurrent stomach (gastric) cancer treated with chemotherapy with celecoxib in Safety and precautions ›

Quality of life and physical function

Celecoxib

Preliminary evidence: People with cancer taking celecoxib during chemotherapy showed better quality of life in one study, better strength (measured by hand grip) in another, and better functional scores in a third.

Indomethacin

Preliminary evidence: People with cancer-related malnutrition taking indomethacin showed better physical function in one study.

Ibuprofen

Preliminary evidence: People with advanced gastrointestinal cancer and cancer-related weight loss taking ibuprofen alongside megestrol acetate (MA) showed better quality of life in one study.

Urinary side effects

Modest evidence: People undergoing immunotherapy for bladder cancer showed fewer urinary symptoms across several studies.

Skin and tissue side effects

Good evidence: People who took celecoxib during capecitabine chemotherapy had a lower risk of hand-foot syndrome across several studies.

NSAIDs combined with other therapies

Reducing cancer risk

Are non-aspirin NSAIDs linked to lower risks of developing cancer or of recurrence? We present the evidence.

Bladder cancer

No evidence: People with bladder cancer taking celecoxib showed no evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on their risk of recurrence across several studies.

Brain cancer

Breast cancer

Recurrence

Celecoxib

No evidence: People with hormone receptor-positive breast cancer treated with celecoxib showed no evidence of an effect on recurrence.

Ibuprofen

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently): People taking ibuprofen at least 3 days per week showed a lower risk of breast cancer recurrence in an observational study.

Ketorolac

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently): People who were treated with ketorolac at the time of breast cancer surgery had a lower risk of recurrence across several observational studies.

Cancer diagnosis

Non-aspirin NSAIDs as a whole

Insufficient (conflicting) evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently): One observational study found a lower risk of breast cancer in specific populations – people of African or European descent, and those with at least one positive hormone receptor, who were currently taking NSAIDs for 6 years or more – but other, larger studies have not found that NSAID affects the risk of cancer diagnosis.

Ibuprofen

Modest evidence: People taking ibuprofen had a lower risk of breast cancer in a combined analysis of studies

Recurrence

Celecoxib

No evidence of an effect on recurrence among people with postmenopausal hormone receptor-positive breast cancer treated with celecoxib for 18 months compared to placeboa pill, medicine, or procedure—thought to be both harmless and ineffective—prescribed for the psychological benefit to the patient or as a sham treatment in a study to allow a comparison to a therapy of interest in a large RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁷¹Strasser-Weippl K, Higgins MJ et al. Effects of celecoxib and low-dose aspirin on outcomes in adjuvant aromatase inhibitor-treated patients: CCTG MA.27. Journal of the National Cancer Institute. 2018 Sep 1;110(9):1003-1008.

Ibuprofen

Lower risk of breast cancer recurrence among people currently use ibuprofen at least 3 days per week compared to no use in a mid-sized observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study⁷²Kwan ML, Habel LA, Slattery ML, Caan B. NSAIDs and breast cancer recurrence in a prospective cohort study. Cancer Causes and Control. 2007 Aug;18(6):613-20.

Ketorolac

Lower risk of recurrence among people with invasive breast cancer, especially among people with high body mass index (BMI), with a single dose of ketorolac at the time of primary tumor surgery compared to no ketorolac in a large observational study, but no evidence of an effect with diclofenac⁷³Desmedt C, Demicheli R et al. Potential benefit of intra-operative administration of ketorolac on breast cancer recurrence according to the patient’s body mass index. Journal of the National Cancer Institute. 2018 Oct 1;110(10):1115-1122.
Lower risk of recurrence (better disease-free survival) in the first few years after mastectomy with ketorolac use around the time of surgery compared to no ketorolac in a mid-sized observational study⁷⁴Retsky M, Demicheli R et al. Reduction of breast cancer relapses with perioperative non-steroidal anti-inflammatory drugs: new findings and a review. Current Medicinal Chemistry. 2013;20(33):4163-76.
Lower risk of recurrence (better disease-free survival) among people undergoing conservative breast cancer surgery with ketorolac compared to no ketorolac in a mid-sized observational study⁷⁵Forget P, Bentin C et al. Intraoperative use of ketorolac or diclofenac is associated with improved disease-free survival and overall survival in conservative breast cancer surgery. British Journal of Anaesthesia. 2014 Jul;113 Suppl 1:i82-7.
Lower rate of recurrence among women undergoing mastectomy with axillary dissection for breast cancer with ketorolac use just before surgery compared to no ketorolac in a mid-sized observational study⁷⁶Forget P, Vandenhende J et al. Do intraoperative analgesics influence breast cancer recurrence after mastectomy? A retrospective analysis. Anesthesia & Analgesia. 2010 Jun 1;110(6):1630-5.

Cancer diagnosis

Non-aspirin NSAIDs as a whole

No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on breast cancer incidence, either overall or by estrogen receptor or progesterone receptor status, among people using non-aspirin NSAIDs in a very large observational study⁷⁷Bardia A, Olson JE et al. Effect of aspirin and other NSAIDs on postmenopausal breast cancer incidence by hormone receptor status: results from a prospective cohort study. Breast Cancer Research and Treatment. 2011 Feb;126(1):149-55.
No evidence of an effect on risk of breast cancer among people with past or current use of non-aspirin NSAIDs, regardless of dose, frequency, or duration of use, either for overall breast cancer or by ER/PR status in a very large observational study⁷⁸Zhang X, Smith-Warner SA et al. Use of aspirin, other nonsteroidal anti-inflammatory drugs, and acetaminophen and postmenopausal breast cancer incidence. Journal of Clinical Oncology. 2012 Oct 1;30(28):3468-77.
No evidence of an effect on risk of breast cancer among people using non-selective NSAIDs, regardless of intensity or duration of use, compared to no use in a very large observational study⁷⁹Cronin-Fenton DP, Pedersen L et al. Prescriptions for selective cyclooxygenase-2 inhibitors, non-selective non-steroidal anti-inflammatory drugs, and risk of breast cancer in a population-based case-control study. Breast Cancer Research. 2010;12(2):R15.
30% lower risk of breast cancer with current use of non-aspirin NSAIDs for 6 or more years, but not with past use (compared to no use), with the lower risk limited to Caucasians, Americans of African descent, and women with at least 1 positive hormone receptor in a very large observational study⁸⁰Gill JK, Maskarinec G et al. Nonsteroidal antiinflammatory drugs and breast cancer risk: the multiethnic cohort. American Journal of Epidemiology. 2007 Nov 15;166(10):1150-8.

Ibuprofen

55% lower risk of breast cancer among people using ibuprofen compared to no use in a pooled analysis of observational studies⁸¹Harris RE, Beebe J, Alshafie GA. Reduction in cancer risk by selective and nonselective cyclooxygenase-2 (COX-2) inhibitors. Journal of Experimental Pharmacology. 2012 Aug 10;4:91-6.
See also higher risk of some types of breast cancer among people using ibuprofen in Safety and precautions ›

Colorectal cancer

Recurrence

Weak evidence: People with stage 3 colon cancer taking long-term celecoxib alongside chemotherapy showed weak evidence of a lower risk of recurrence in one study.

Colorectal cancer risk

People with with Familial Adenomatous Polyposis (FAP)

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) for specific patients: People with FAP who took celecoxib and sundilac had a lower number of polyps and aberrant crypt foci across several studies.

NSAIDS combined with other treatments

Modest evidence: People with FAP taking a combination of erlotinib, eicosapentaenoic acid, and sundilac had smaller polyp sizes in a combined analysis of studies.

NSAIDs as a whole

Good (though mixed) evidence: People taking NSAIDs had a lower risk of colon cancer and risk factors for colon cancer, such as adenomas, across several studies, although one recent combined analysis did not find this effect.

Selective cyclooxygenase-2 (COX-2) inhibitors as a whole

Preliminary evidence: Lower colorectal cancer risk among people using COX-2 inhibitors

Celecoxib

Strong evidenceconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently): People taking celecoxib had a lower risk of adenomas and advanced adenomas, precursors of colon cancer, across several studies.

Ibuprofen

Preliminary evidence: People taking ibuprofen had a lower risk of colon cancer in one study.

Recurrence

A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently toward slightly lower disease recurrence among people with stage 3 colon cancer with 3 years of celecoxib (Celebrex) added to standard adjuvant fluorouracil, leucovorin, and oxaliplatin (FOLFOX) compared to FOLFOX alone in a very large RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁸²Meyerhardt JA, Shi Q. Effect of celecoxib vs placebo added to standard adjuvant therapy on disease-free survival among patients with stage III colon cancer: the CALGB/SWOG 80702 (Alliance) randomized clinical trial. JAMA. 2021 Apr 6;325(13):1277-1286.

Colorectal cancer risk

People with with Familial Adenomatous Polyposis (FAP)

Fewer polyps among people with FAP taking celecoxib or celecoxib combined with sundilac, with people taking celecoxib at a dose of 16mg per kilogram of body weight daily showing the lowest number of polyps, in a combined analysis of 23 RCTs⁸³Luo P, Shi W et al. Which drugs are more effective in preventing familial adenomatous polyposis progression based on network meta-analysis? Current Pharmaceutical Design. 2024;30(20):1548-1563.
Fewer aberrant crypt foci after 2 months, and fewer adenomas and a weak trend toward fewer total polyps at 12 months, among people without polyps or who had undergone polypectomy treated with sulindac 300 mg daily, and more benefit among those who had undergone polypectomy in a mid-sized RCT⁸⁴Takayama T, Nagashima H et al. Randomized double-blind trial of sulindac and etodolac to eradicate aberrant crypt foci and to prevent sporadic colorectal polyps. Clinical Cancer Research. 2011 Jun 1;17(11):3803-11.
Fewer recurrences of adenomas among people with a history of resected adenomas treated with 500 mg difluoromethylornithine (DFMO) and 150 mg sulindac daily, without a significant increase in adverse events in a mid-sized RCT⁸⁵Meyskens FL Jr, McLaren CE et al. Difluoromethylornithine plus sulindac for the prevention of sporadic colorectal adenomas: a randomized placebo-controlled, double-blind trial. Cancer Prevention Research (Philadelphia). 2008 Jun;1(1):32-8.

NSAIDS combined with other treatments

Smallest polyp size among people with familial adenomatous polyposis (FAP) taking a regimen of erlotinib, eicosapentaenoic acid, and sundilac, compared to sundilac plus celecoxib or celecoxib alone, in a combined analysis of 23 RCTs⁸⁶Luo P, Shi W et al. Which drugs are more effective in preventing familial adenomatous polyposis progression based on network meta-analysis? Current Pharmaceutical Design. 2024;30(20):1548-1563.

NSAIDS as a whole

No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on proximal colon cancer risk among people taking NSAIDs in a combined analysis of 13 studies⁸⁷Harewood R, Disney R et al. Medication use and risk of proximal colon cancer: a systematic review of prospective studies with narrative synthesis and meta-analysis. Cancer Causes & Control. 2021 Oct;32(10):1047-1061.
Slightly lower risk of recurring colorectal adenoma (noncancerous growths that can become cancerous) among people taking NSAIDs, but not as great a reduction as some other drugs, among people with a history of colorectal adenomas in a combined analysis of 45 RCTs⁸⁸Tan S, Ou Y et al. Preventive effects of chemical drugs on recurrence of colorectal adenomas: systematic review and Bayesian network meta-analysis. European Journal of Gastroenterology and Hepatology. 2024 Jan 1;36(1):62-75.
Lower risk of colorectal cancer among people aged 40 or older with non-aspirin NSAID use compared to no use, especially for women (19% lower risk), higher doses (18% lower risk), distal colon cancer (22% lower risk) and white people (31–41% lower risk) in a very large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 23 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies⁸⁹Tomić T, Domínguez-López S, Barrios-Rodríguez R. Non-aspirin non-steroidal anti-inflammatory drugs in prevention of colorectal cancer in people aged 40 or older: a systematic review and meta-analysis. Cancer Epidemiology. 2019;58:52–62.
Lower risk of colorectal cancer at 3 years after a negative baseline colonoscopy, but not at longer follow up, among people taking non-aspirin NSAIDs before colonoscopy compared to no NSAIDs in a very large observational study⁹⁰Cheung KS, Chen L, Chan EW, Seto WK, Wong ICK, Leung WK. Nonsteroidal anti-inflammatory drugs but not aspirin are associated with a lower risk of post-colonoscopy colorectal cancer. Alimentary Pharmacology & Therapeutics. 2020;51:899–908.
35% lower risk of proximal and 31% lower risk of distal colon cancer, but no evidence of an effect on rectal cancer among people using non-aspirin NSAIDs daily compared to non-users in a very large observational study⁹¹Ruder EH, Laiyemo AO et al. Non-steroidal anti-inflammatory drugs and colorectal cancer risk in a large, prospective cohort. American Journal of Gastroenterology. 2011 Jul;106(7):1340-50.
Substantially lower risk of colorectal cancer among people using non-aspirin NSAIDs, particularly long-term, high-intensity use of selective COX-2 inhibitors compared to no use in a very large observational study⁹²Friis S, Riis AH, Erichsen R, Baron JA, Sørensen HT. Low-dose aspirin or nonsteroidal anti-inflammatory drug use and colorectal cancer risk: a population-based, case-control study. Annals of Internal Medicine. 2015 Sep 1;163(5):347-55.
Lower risk of colon cancer among people using selective COX-2 inhibitors, ibuprofen, or naproxen compared to no use in a mid-sized observational study⁹³Harris RE, Beebe-Donk J, Alshafie GA. Similar reductions in the risk of human colon cancer by selective and nonselective cyclooxygenase-2 (COX-2) inhibitors. BMC Cancer. 2008 Aug 14;8:237.
Lower risk of adenomatous polyps among people using non-aspirin NSAIDs compared to no use in a large observational study⁹⁴Murff HJ, Shrubsole MJ et al. Nonsteroidal anti-inflammatory drug use and risk of adenomatous and hyperplastic polyps. Cancer Prevention Research (Phila). 2011 Nov;4(11):1799-807.

Selective cyclooxygenase-2 (COX-2) inhibitors as a whole

70% lower risk of colon cancer among people using selective cyclooxygenase-2 (COX-2) inhibitors compared to no use in a mid-sized observational study⁹⁵Harris RE, Beebe J, Alshafie GA. Reduction in cancer risk by selective and nonselective cyclooxygenase-2 (COX-2) inhibitors. Journal of Experimental Pharmacology. 2012 Aug 10;4:91-6.

Celecoxib

Lower risk of recurrent adenomas (34% lower risk) and advanced adenomas (55% lower risk) over a 3-year follow-up among people using celecoxib 400 mg/day compared to controls, and an increased risk 2 years after celecoxib use was stopped, in a meta-analysis of 5 RCTs⁹⁶Veettil SK, Lim KG et al. Effects of aspirin and non-aspirin nonsteroidal anti-inflammatory drugs on the incidence of recurrent colorectal adenomas: a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials. BMC Cancer. 2017 Nov 14;17(1):763.
Somewhat fewer adenomas and moderately fewer advanced adenomas over 5 years among people at high risk for colorectal cancer taking either low or high doses of celecoxib for 3.1 years (discontinued due to safety concerns) in a very large RCT⁹⁷Bertagnolli MM, Eagle CJ et al; Adenoma Prevention with Celecoxib Study Investigators. Five-year efficacy and safety analysis of the Adenoma Prevention with Celecoxib Trial. Cancer Prevention Research (Phila). 2009 Apr;2(4):310-21.
36% lower rate of adenomas and 51% lower rate of advanced adenomas after 3 years among people who had had adenomas removed before enrollment taking 400 mg celecoxib daily compared to placebo in a very large RCT⁹⁸Arber N, Eagle CJ et al; PreSAP Trial Investigators. Celecoxib for the prevention of colorectal adenomatous polyps. New Engand Journal of Medicine. 2006 Aug 31;355(9):885-95.
Fewer adenomas at 1 and 3 years among people who had adenomas removed before study entry taking 200 mg celecoxib or 400 mg celecoxib twice a day compared to placebo, with the greatest effects among people whose pretreatment adenomas demonstrated elevated COX-2 or 15-PGDH loss in a very large RCT⁹⁹Wang J, Cho NL et al. Chemopreventive efficacy of the cyclooxygenase-2 (Cox-2) inhibitor, celecoxib, is predicted by adenoma expression of Cox-2 and 15-PGDH. Cancer Epidemiology, Biomarkers & Prevention. 2018 Jul;27(7):728-736.

Ibuprofen

72% lower risk of colon cancer among people using ibuprofen compared to no use in a mid-sized observational study¹⁰⁰Harris RE, Beebe J, Alshafie GA. Reduction in cancer risk by selective and nonselective cyclooxygenase-2 (COX-2) inhibitors. Journal of Experimental Pharmacology. 2012 Aug 10;4:91-6.

Gastrointestinal cancer

Colorectal cancer is listed separately.

Bile duct cancer

No evidence: People taking NSAIDs did not show evidence of an effect on their risk of bile duct cancer in a combined analysis of studies.

Esophageal cancer

Modest evidence: People with Barett’s esophagus who took NSAIDs, including aspirin, had a lower risk of esophageal adenocarcinoma in one large study.

Hepatocellular carcinoma

No evidence: People taking NSAIDs did not show an effect on their risk of hepatocellular carcinoma in a combined analysis of studies.

Head and neck cancer

Weak evidence: People taking NSAIDs showed weak evidence of a lower risk of head and neck cancer among people in a combined analysis of studies.

Lung cancer

Modest evidence: People taking ibuprofen or COX-2 inhibitors, such as celecoxib, had a lower risk of lung cancer across three studies.

Melanoma and other skin cancer

Good evidence: People taking NSAIDs had a lower risk of skin cancers in one very large study.

Prostate cancer

Preliminary (conflicting) evidence: People taking non-aspirin NSAIDs had a lower risk of prostate cancer in several studies, but one large study did not find this effect.

NSAIDs combined with other therapies

Modest evidence: People with higher chondroitin and glutamine intake also taking NSAIDs showed a lower risk of colorectal and lung cancers across several studies.

Keep reading about non-aspirin NSAIDs

See all our reviews of complementary therapies

Authors

Nancy Hepp, MS

past Lead Researcher

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Sophie Kakarala

Research Assistant

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Reviewers

Walter Tsang, MD

Integrative oncologist

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Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant

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Barry D. Elson, MD

Integrative physician and CancerChoices advisor

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Andrew Jackson, ND

Research Associate

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Last update: June 9, 2025

Last full literature review: September 2021; updated May 2025 by Sophie Kakarala

Walter Tsang, MD, reviewed the May 2025 version. Laura Pole, RN, MSN, OCNS, Barry Elson, MD, and Andrew Jackson, ND reviewed the August 2022 version.

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

Non-aspirin Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

How can non-aspirin NSAIDs help you? What the research says

COX inhibitors

Improving treatment outcomes

Optimizing your body terrain

Managing side effects and promoting wellness

Reducing cancer risk

Keep reading about non-aspirin NSAIDs

Authors

Nancy Hepp, MS

Sophie Kakarala

Reviewers

Walter Tsang, MD

Laura Pole, MSN, RN, OCNS

Barry D. Elson, MD

Andrew Jackson, ND

Learn more

Aspirin

Self Care

Integrative Medicine at NCI Cancer Centers

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