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NSAIDS and Aspirin May Help Prevent Colon Cancer

Breaking News - August 2005 - Week 5

(Aug 31, 2005)

Healthcare in  the News

-- Persons who take aspirin or non-steroidal anti-inflammatory medications (NSAIDS) such as Advil® or Motrin® to treat their arthritis or other pain may also be lowering their risk of colorectal cancer, according to a report in the Journal of the American Medical Association (JAMA).

A picture of a pharmacist selecting a medication

Researchers report that long-term use of aspirin or NSAIDs cuts that risk by as much as 53 percent. The risk reduction depended on the dose taken weekly and the number of years the medication was taken.

"Regular long-term use of aspirin did reduce the risk of colorectal cancer," says the study's lead author, Dr. Andrew Chan, an instructor of medicine at Harvard Medical School and a staff physician at Massachusetts General Hospital in Boston.

Benefits vs Side Effects

Dr. Chan also urged caution, because long-term use of these medications can cause serious side effects, including gastrointestinal bleeding. He says the researchers were not recommending either aspirin or NSAIDs for routine colorectal cancer prevention.

"You have to weigh both the risks of colorectal cancer and the side effects of using these drugs," he notes. "There are other prevention strategies, like colorectal cancer screening, and we need to examine what the benefit of aspirin would be above and beyond current prevention."

The American Cancer Society (ACS) agrees. In a statement, Eric Jacobs, a senior epidemiologist for the society, says that "use of aspirin at any dose to prevent cancer is not recommended by the American Cancer Society or any other group because of the potential for serious side effects."

Although advances have been made in screening and detection of colorectal cancer, it still remains the second most deadly form of the disease, after lung cancer. Each year, about 56,000 Americans die from colorectal cancer and 145,000 people will be newly diagnosed with the illness, according to the ACS.

Using information from the prospective Nurses' Health Study, the researchers examined data on nearly 83,000 women who had been providing information on their medication use at least every two years. The women were between 30 and 55 at the start of the study.

In this group, 962 women developed colorectal cancer during the 20-year study period.

Women who regularly used aspirin were at a 23 percent reduced risk of colorectal cancer compared to non-regular aspirin users, according to the study. Significant risk reduction did not appear until after a decade of use, however.

The researchers also found that the more aspirin the women took, the lower their colorectal cancer risk. Women who took two to five standard aspirin tablets weekly had an 11 percent reduced risk compared to non-users.

The risk fell by 22 percent among women who took six to 14 tablets weekly, while women taking more than 14 aspirin tablets a week had a 32 percent decrease in their risk of colorectal cancer.

Women who took more than 14 tablets weekly for more than 10 years had the greatest risk reduction, 53 percent, according to the researchers.

However, Dr. Chan explains that women on the highest doses of aspirin also increased their risk of gastrointestinal bleeding by 57 percent.

Dose also mattered for NSAIDs - medications that include Advil, Aleve®, and Motrin. Women taking two to five tablets a week lowered their colorectal cancer risk by 9 percent, while those taking six to 14 tablets weekly had a 31 percent decreased risk. Women taking more than 14 NSAID doses a week reduced their risk by 46 percent, according to the study.

NSAIDs were also associated with an increased risk of gastrointestinal bleeding, Dr. Chan says.

Tylenol® Has No Effect, Celebrex® Not Studied

Dr. Chan remarks that the researchers also looked at the effects of acetaminophen (Tylenol) and were not surprised when they found no benefit. That is because the researchers suspect that inhibition of the enzyme COX-2 - something both aspirin and NSAIDs do - may be what is reducing colorectal cancer risk. Acetaminophen does not inhibit COX-2.

Two prescription COX-2 inhibitor NSAIDS - Vioxx® and Bextra® - have been pulled from the market because long-term use has been linked to serious cardiovascular side effects, but one such medication, Celebrex®, remains on drugstore shelves. Dr. Chan said his team's study was unable to determine whether long-term use of over-the-counter NSAIDs might have similar effects.

While the researchers are not recommending the routine use of aspirin or NSAIDs for colorectal cancer prevention, Dr. Chan says there may be a use for these medications in some patients, perhaps those at an especially high risk for the malignancy. But, he says, it is too soon to know for sure.

What this study does do, he says, is "validate our understanding of the mechanism behind colorectal cancer and opens further avenues of research."

Both Drs. Chan and Jacobs say the best way to prevent colorectal cancer is to undergo regular colorectal cancer screenings beginning at age 50, or even sooner for individuals at high risk for the disease.

Always consult your physician for more information.

For more information on health and wellness, please visit health information modules on this Web site.


Screening Guidelines for Colorectal Cancer

The American Cancer Society provides colorectal cancer screening guidelines for 2005.

Beginning at age 50, both men and women should follow one of the examination schedules below:

  • fecal occult blood test (FOBT) every year
  • flexible sigmoidoscopy (FSIG) every five years
  • both annual FOBT and FSIG every five years
  • double-contrast barium enema every five years
  • colonoscopy every 10 years

Persons with any of the following colorectal cancer risk factors should begin screening procedures at an earlier age and be screened more often:

  • strong family history of colorectal cancer or polyps in a first-degree relative, in a parent or sibling before the age of 60, or in two first-degree relatives of any age
  • family with hereditary colorectal cancer syndromes, such as familial adenomatous polyposis (FAP) and hereditary nonpolyposis colon cancer (HNPCC)
  • personal history of colorectal cancer or adenomatous polyps
  • personal history of chronic inflammatory bowel disease

Although the exact cause of colorectal cancer is not known, it is possible to prevent many colon cancers with the following:

diet and exercise
It is important to manage the risk factors you can control, such as diet and exercise. Eating more fruits, vegetables, and whole grain foods, and avoiding high-fat, low-fiber foods, plus appropriate exercise, even small amounts on a regular basis, can be helpful.

medication therapy
Some studies have shown that low doses of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, and estrogen replacement therapy for post-menopausal women may reduce the risk of colorectal cancer. Discuss this with your physician.

screenings
Perhaps most important to the prevention of colorectal cancer is having screening tests at appropriate ages. Because some colorectal cancers cannot be prevented, finding them early is the best way to improve the chance of successful treatment, and reduce the number of deaths caused by colorectal cancer.

Always consult your physician for a diagnosis.


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