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NSAIDs can reduce colorectal cancer risk
24-Jul-2007
Medical Studies/Trials
A study of Medicare patients with osteoarthritis provides additional
evidence that non-steroidal anti-inflammatory drugs (NSAIDs) such as
aspirin reduce the risk of colorectal cancer.
Earlier investigations of the drugs, impact on tumor development could
not rule out the possibility that an observed protective effect was
caused by other preventive health care measures. The current study, led
by a Massachusetts General Hospital (MGH) physician, appears in the
August 2007 Journal of General Internal Medicine.
"This is good news for people who take NSAIDs regularly for
osteoarthritis," says Elizabeth Lamont, MD, MS, of the MGH Cancer
Center, the study's lead author. "Although patients face risks such as
bleeding or kidney damage from this therapy, they probably are at a
lower risk of developing colorectal cancer." Because of the risks posed
by the dosage used to treat osteoarthritis, she and her co-authors
stress that currently available NSAIDs should not be used solely to
prevent cancer.
Earlier randomized trials clearly showed that NSAID treatment can
prevent the development of precancerous colorectal polyps, but whether
or not such therapy also reduces the risk of invasive colorectal cancer
has not yet been confirmed. Those trials used relatively low doses of
aspirin and showed no significant differences in colorectal cancer
rates between the aspirin and placebo groups. While many observational
studies have shown a protective effect of NSAIDs against colorectal
cancer, interpretation of some of those results may have been clouded
by other healthy behaviors of the participants.
"It would be ideal to conduct a randomized clinical trial , in which
half the patients receive NSAIDs at doses higher than those used in
prior trials and half receive placebos , and follow both groups for
many years for evidence of cancer. But such trials are expensive, time
consuming, and could present real health risks to participants.
Therefore, we took advantage of a natural ,experiment, by comparing
data from patients known to regularly take higher amounts of NSAIDs
with that from those taking lower doses in order to evaluate any effect
on colorectal cancer risk."
First the researchers reviewed data from the 1993-94 National
Ambulatory Medical Care Survey, in which physicians report on the
diagnoses of and treatments prescribed to patients seen during a
randomly selected week. Those results verified that older patients with
osteoarthritis were more than four times as likely to take NSAIDs as
were those without osteoarthritis. They then analyzed information from
the Survival Epidemiology and End-Results (SEER)-Medicare program,
studying groups of elderly Medicare patients with and without
colorectal cancer, to search for associations with NSAID use.
Comparing information on 4,600 individuals with
colorectal cancer to data from 100,000 controls, they found that a
history of osteoarthritis was associated with a 15 percent reduction in
the likelihood of a colorectal cancer diagnosis. A similar association
was seen when total knee replacement was used as a marker for NSAID
treatment.
"The magnitude of colorectal cancer risk reduction
between patients with and without osteoarthritis is completely
consistent with the risk reduction for pre-cancerous polyps reported in
clinical trials of NSAIDs," Lamont says. "Confirming this association
supports the need for further research to identify NSAID agents safe
enough to be used for regular, preventive therapy by the general
population."
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