Effect of aspirin and NSAIDs on risk and survival from colorectal cancer

• Published in: Gut Vol. 59; no. 12; pp. 1670 - 1679
• Main Authors: Din, Farhat V N, Theodoratou, Evropi, Farrington, Susan M, Tenesa, Albert, Barnetson, Rebecca A, Cetnarskyj, Roseanne, Stark, Lesley, Porteous, Mary E, Campbell, Harry, Dunlop, Malcolm G
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.12.2010; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adolescent; Adult; Age; Aged; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Anticarcinogenic Agents - administration & dosage; Anticarcinogenic Agents - therapeutic use; Aspirin; Aspirin - administration & dosage; Aspirin - therapeutic use; Bias; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; cancer prevention; chemoprevention; Colorectal cancer; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - prevention & control; Confounding Factors (Epidemiology); Diet - statistics & numerical data; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug dosages; Epidemiologic Methods; Family medical history; Female; Gastroenterology. Liver. Pancreas. Abdomen; Health risk assessment; Humans; Life Style; Lifestyles; Male; Medical sciences; Middle Aged; Mortality; non-steroidal anti-inflammatory drugs; NSAIDs; Pharmacology. Drug treatments; Population; Poverty - statistics & numerical data; Scotland - epidemiology; Smoking - epidemiology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Studies; Surveillance; Tumors; Womens health; Young Adult; Scotland; Prostaglandin-endoperoxide synthase; Rectal disease; Prognosis; Enzyme; Colorectal cancer; Enzyme inhibitor; Malignant tumor; Acetylsalicylic acid; Survival; Antiplatelet agent; Colonic disease; Non steroidal antiinflammatory agent; Analgesic; Risk factor; Gastroenterology; Antipyretic; Digestive diseases; Intestinal disease; Oxidoreductases; Salicylates; Cancer
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gut.2009.203000

BackgroundPrevious studies have shown that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) lower colorectal cancer (CRC) risk. However, the lowest effective NSAID dose, treatment duration, and effects on survival are not defined. In a large population-based case–control study, we have explored the relationship between NSAID dose and duration, CRC risk and overall CRC-specific survival.MethodsThe relationship between NSAID use and CRC risk was examined in 2279 cases and 2907 controls. Subjects completed food-frequency and lifestyle questionnaires. NSAID categories were low-dose aspirin (75 mg), non-aspirin NSAIDs (NA-NSAIDs) and any NSAID. Users were defined as taking >4 tablets/week for >1 month. ORs were calculated by logistic regression models and adjusted for potential confounding factors. Effect of NSAID use on all-cause and CRC-specific mortality was estimated using Logrank tests and Cox's hazard models.ResultsIn all, 354 cases (15.5%) were taking low-dose aspirin compared to 526 controls (18.1%). Low-dose aspirin use was associated with decreased CRC risk (OR 0.78 95% CI 0.65 to 0.92, p=0.004), evident after 1 year and increasing with duration of use (ptrend=0.004). NA-NSAID and any NSAID use were also inversely associated with CRC. There was no demonstrable effect of NSAIDS on all-cause (HR 1.11, p=0.22, 0.94–1.33) or CRC-specific survival (HR 1.01, p=0.93, 0.83–1.23).ConclusionThis is the first study to demonstrate a protective effect against CRC associated with the lowest dose of aspirin (75 mg per day) after only 5 years use in the general population. NSAID use prior to CRC diagnosis does not influence survival from the disease.