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

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

Abstract

Background Previous 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.
Methods The 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.
Results In 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).
Conclusion This 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

Citation

Din, F. V. N., Theodoratou, E., Farrington, S. M., Tenesa, A., Barnetson, R. A., Cetnarskyj, R., …Dunlop, M. G. (2010). Effect of aspirin and NSAIDs on risk and survival from colorectal cancer. Gut, 59, 1670-1679. https://doi.org/10.1136/gut.2009.203000

• Journal Article Type: Article
• Publication Date: 2010
• Deposit Date: Mar 13, 2014
• Print ISSN: 0017-5749
• Electronic ISSN: 1468-3288
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 59
• Pages: 1670-1679
• DOI: https://doi.org/10.1136/gut.2009.203000
• Keywords: Aspirin; non-steroidal anti-inflammatory drugs (NSAIDs); colorectal cancer
• Public URL: http://researchrepository.napier.ac.uk/id/eprint/6615
• Publisher URL: http://dx.doi.org/10.1136/gut.2009.203000