A recently published study in The Lancet has shown that low dose aspirin (acetylsalicylic acid) intake reduces the incidence and mortality of colorectal cancer. The study followed participants of four randomized controlled trials of aspirin against control and one trial of different doses of aspirin with a median follow-up period of 18.3 years. The risk reduction was greatest in case of proximal colon cancers and this is important as they are difficult to detect by screening colonoscopy. It may be possible to formulate a screening and prevention program consisting of aspirin intake and regular screening to cover both proximal and distal colon. However, it appears that the aspirin intake needs to be continued for five years to have an effect.
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| Aspirin - new role? From wikimedia commons |
The main concern about the risk of aspirin intake is the risk of GI ulceration and subsequent bleeding. The question is if the risk of GI side effects from aspirin outweighs the benefit of colon cancer prevention. In an ongoing poll at the doc2doc community of the BMJ group, the opinion seems to be divided. When I last checked, 27.38% of the respondents said that aspirin should be prescribed daily to prevent colon cancer, 42.85% of the responders said it shouldn’t be prescribed while 29.77% were unsure. Enteric coated aspirin may provide an answer. Evidence from healthy volunteers shows reduced incidence of ulceration in short term cases but long term data on aged patients is not there.
A new preparation of aspirin, aspirin-phosphatidylcholine complex (PL2200) was tested by Byron Cryer et al. in an industry supported phase II trial. The participants were healthy subjects and received either aspirin or PL2200 for 7 days. The incidence of gastroduodenal ulcers were significantly more in the aspirin group than the PL2200 group. But, this was a study on healthy population and for short duration, will the gastroprotective effect persist in long term cases as required for colorectal cancer prevention? This remains to be seen.
Update: The poll at doc2doc has concluded, 32.6% of the responders were in favor of prescribing aspirin, 40% said it shouldn't be prescribed and 27.4% were unsure.
Reference:
Update: The poll at doc2doc has concluded, 32.6% of the responders were in favor of prescribing aspirin, 40% said it shouldn't be prescribed and 27.4% were unsure.
Reference:
Rothwell, P., Wilson, M., Elwin, C., Norrving, B., Algra, A., Warlow, C., & Meade, T. (2010). Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials The Lancet, 376 (9754), 1741-1750 DOI: 10.1016/S0140-6736(10)61543-7
Cryer, B., Bhatt, D., Lanza, F., Dong, J., Lichtenberger, L., & Marathi, U. (2010). Low-Dose Aspirin-Induced Ulceration Is Attenuated by Aspirin–Phosphatidylcholine: A Randomized Clinical Trial The American Journal of Gastroenterology DOI: 10.1038/ajg.2010.436
Walker, J., Robinson, J., Stewart, J., & Jacob, S. (2007). Does enteric-coated aspirin result in a lower incidence of gastrointestinal complications compared to normal aspirin? Interactive CardioVascular and Thoracic Surgery, 6 (4), 519-522 DOI: 10.1510/icvts.2007.155788
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4 comments:
Great post! I'm always amazed that a molecule as simple as aspirin can do so much. An expanded version of the aspirin study has just been published suggesting that long-term aspirin use not only significantly reduces the risk of death from colorectal cancer but also from a variety of solid tumor cancers such as lung, esophageal, and gastrointestinal cancers. It seems that many doctors are hesitant to prescribe aspirin solely as a cancer preventative on the basis of this study, but it will be interesting to see if these results encourage the development of safer aspirin formulations like the one you've mentioned here. I'd also be interested in possible future research into the biological mechanism by which aspirin reduces cancer risk. I wrote more about this new aspirin study here:
http://smellslikescience.com/daily-aspirin-may-reduce-risk-of-cancer-death/
Thanks Dan for the update. Here is the link to the new study - http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62110-1/abstract
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