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We aimed to assess the association between contemporary NSAID use (\u2265180 days) and gastrointestinal cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Nationwide Swedish population-based cohort study (2005\u20132012).<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Sweden<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>All adults exposed to maintenance NSAIDs use (aspirin, n=783 870; unselective NSAIDs, n=566 209, selective cyclo-oxygenase (COX)-2 inhibitors, n=17 948) compared with the Swedish background population of the same age, sex and calendar period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome measures<\/jats:title><jats:p>The risk of different gastrointestinal cancer types expressed as standardised incidence ratios (SIR) and 95% CIs, taking into account concurrent proton pump inhibitors (PPIs) and statins usage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The SIR for gastrointestinal cancer for aspirin use was 1.02 (95% CI 1.00 to 1.04), with clearly reduced risk for long-term users (SIR=0.31, 95%\u2009CI 0.30 to 0.33 for 5.5\u20137.7 years), but an increased risk for short-term users (SIR=2.77, 95%\u2009CI 2.69 to 2.85), and stronger protective effect for low-dose aspirin (SIR=0.86, 95%\u2009CI 0.85 to 0.88). Users of non-selective NSAIDs showed an overall decreased risk of gastrointestinal cancer (SIR=0.79, 95%\u2009CI 0.77 to 0.82), in particular for cancer of the stomach, colorectum and oesophagus, and the SIRs were further decreased among long-term users. Users of selective COX-2 inhibitors showed a SIR=0.89 (95% CI 0.73 to 1.09) for gastrointestinal cancers. Both aspirin and unselective NSAIDs users who also were using PPIs, had higher risks for all gastrointestinal cancer types; and lower risk if using statins.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Long-term use of (low-dose) aspirin and non-selective NSAIDs was associated with a decreased risk of all gastrointestinal cancer types.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2018-021869","type":"journal-article","created":{"date-parts":[[2018,7,7]],"date-time":"2018-07-07T12:15:36Z","timestamp":1530965736000},"page":"e021869","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Maintenance use of non-steroidal anti-inflammatory drugs and risk of gastrointestinal cancer in a nationwide population-based cohort study in Sweden"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0137-447X","authenticated-orcid":false,"given":"Nele","family":"Brusselaers","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5143-5448","authenticated-orcid":false,"given":"Jesper","family":"Lagergren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,7,7]]},"reference":[{"key":"2020050713390038000_8.7.e021869.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)04046-0"},{"key":"2020050713390038000_8.7.e021869.2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.rheumatology.a031493"},{"key":"2020050713390038000_8.7.e021869.3","doi-asserted-by":"crossref","unstructured":"Yang M , Wang HT , Zhao M , et al . 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