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Senior Citizens Taking NSAIDS Like Aspirin Reduce Risk of Colorectal Cancer
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, at least for older
people. The researchers, however, quickly add that currently available
NSAIDs should not be used solely to prevent 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
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 was not 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
“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
“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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