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The purpose of this study was to evaluate the prognostic significance of COX\u20102 tumor expression according to adjuvant treatment, and potential effect modifications of non\u2010steroid anti\u2010inflammatory drug (NSAID) use, and other tumor and lifestyle factors. A prospective cohort of 1,116 patients with primary breast cancer in Lund, Sweden, included 2002\u20102012 was followed until June 2014 (median 5 years). Tumor\u2010specific COX\u20102 expression was evaluated on tissue microarrays using immunohistochemistry. Associations between COX\u20102 intensity (negative, weak\u2010moderate, high) and patient and tumor characteristics as well as prognosis were analyzed. Tumor\u2010specific COX\u20102 expression was available for 911 patients and was significantly associated with higher age at diagnosis and less aggressive tumor characteristics. Higher COX\u20102 expression was associated with lower risk for breast cancer events during the first five years of follow\u2010up, <jats:sub>adj<\/jats:sub>HR 0.60 (95%CI: 0.37\u20100.97), per category. The association between COX\u20102 expression and prognosis was significantly modified by oral contraceptive (OC) use (<jats:italic>P<\/jats:italic><jats:sub>interaction<\/jats:sub>\u2009=\u20090.048), preoperative NSAID use (<jats:italic>P<\/jats:italic><jats:sub>interaction<\/jats:sub>\u2009=\u20090.009), and tumor size (<jats:italic>P<\/jats:italic><jats:sub>interaction<\/jats:sub>\u2009=\u20090.039). COX\u20102 negativity was associated with increased risk for events during the first five years in ever OC users, <jats:sub>adj<\/jats:sub>HR 1.94 (1.01\u20103.72) and during the 11\u2010year follow\u2010up in preoperative NSAID users, <jats:sub>adj<\/jats:sub>HR 4.51 (1.18\u201011.44) as well as in patients with large tumors, <jats:sub>adj<\/jats:sub>HR 2.57 (1.28\u20105.15). In conclusion, this study, one of the largest evaluating COX\u20102 expression in breast cancer, indicates that the prognostic impact of COX\u20102 expression depends on host factors and tumor characteristics.<\/jats:p>","DOI":"10.1002\/ijc.30432","type":"journal-article","created":{"date-parts":[[2016,9,15]],"date-time":"2016-09-15T23:02:59Z","timestamp":1473980579000},"page":"163-175","source":"Crossref","is-referenced-by-count":22,"title":["The prognostic impact of COX\u20102 expression in breast cancer depends on oral contraceptive history, preoperative NSAID use, and tumor size"],"prefix":"10.1002","volume":"140","author":[{"given":"Maria","family":"Simonsson","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology Lund University Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofie","family":"Bj\u00f6rner","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, 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