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Aspirin Reduces Risk of Colon Cancer for Women but
Takes 10 Years
Taking two regular aspirin a week “significantly
reduced risk,” study says
Aug. 23, 2005 - Women who took two or more aspirin
or NSAIDs per week for more than 10 years significantly reduced their
risk of colorectal cancer, according to an article in the August 24/31
issue of JAMA. Women who took even more aspirin – 14 per week – reduced
their risk by half but greatly increased the risk for major
gastrointestinal bleeding.
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Recent randomized intervention trials have
demonstrated that regular use of aspirin in patients with a history of
colorectal adenoma (benign tumor) or cancer reduces the risk of
recurrent tumor within one to three years, according to background
information in the article. However, whether long-term use of aspirin
similarly reduces the risk of colorectal cancer and, if so, at what
dose, has been unclear.
Andrew T. Chan, M.D., M.P.H., of Massachusetts
General Hospital and Harvard Medical School, Boston, and colleagues
examined the influence of aspirin and nonaspirin nonsteroidal
anti-inflammatory drugs (NSAIDs) on the risk of colorectal cancer in a
large group of women.
The study included 82,911 women, enrolled in the
Nurses' Health Study, who have been providing data on medication use
biennially since 1980 and followed up through June 1, 2000.
Over the 20-year period, 962 cases of colorectal
cancer were documented. Among women who regularly used aspirin (2 or
more standard - 325-mg - tablets per week), there was a 23 percent
reduced relative risk for colorectal cancer compared with nonregular
users. However, significant risk reduction was not observed until more
than 10 years of use.
The benefit appeared related to dose: compared with
women who reported no use, the relative risk for cancer was 10 percent
greater for women who used 0.5 to 1.5 standard aspirin tablets per week;
11 percent lower with 2 to 5 aspirin per week; 22 percent lower with 6
to 14 aspirin per week; and 32 percent lower with more than 14 aspirin
per week.
Women who took more than 14 aspirin per week for
longer than 10 years had a 53 percent lower relative risk for colorectal
cancer. A similar dose-response relationship was found for nonaspirin
NSAIDs.
The incidence of reported major gastrointestinal
bleeding events per 1000 person-years also appeared to be dose-related:
0.77 among women who denied any aspirin use; 1.07 for 0.5 to 1.5
standard aspirin tablets per week; 1.07 for 2 to 5 aspirin per week;
1.40 for 6 to 14 aspirin per week; and 1.57 for more than 14 aspirin per
week.
"Our study supports a possible role for aspirin in
cancer prevention, which has been demonstrated by prior adenoma
recurrence trials. However, any substantial impact of aspirin on cancer
necessitates early initiation and prolonged, consistent use.
“Moreover, optimal chemoprevention may require
substantially higher doses of aspirin than currently recommended for the
prevention of cardiovascular disease.
“Many toxicities of aspirin, including
gastrointestinal bleeding, are dose-dependent. Thus, future studies will
need to thoroughly consider the risk-benefit profile for aspirin/NSAID
chemoprevention among various risk groups and compare such a strategy
with other potential prevention efforts," the authors said.
“Although our study was limited to women, previous
reports have also demonstrated a protective effect for aspirin in men,”
the authors added.
Editor's Note: This study was supported by grants
from the National Cancer Institute, National Institutes of Health. Dr.
Chan is a recipient of the American Gastroenterological
Association/Foundation for Digestive Health and Nutrition Research
Scholar Award and a career development award from the National Cancer
Institute.
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