A study finds that long-term aspirin use before a diagnosis of colorectal cancer (CRC) may be associated with lower CRC-specific mortality, found an American Cancer Society cohort study.
The report suggests that the findings for pre-diagnosis aspirin use might help reduce CRC mortality in the overall population by limiting metastatic spread of colorectal tumours before diagnosis. Preventing distant metastases leads to fewer deaths from colorectal cancer.
The study, led by Dr Peter T Campbell, of the American Cancer Society, used data from men and women enrolled in the American Cancer Society's Cancer Prevention Study-II (CPS-II) Nutrition Cohort who were cancer-free at the baseline (year 1992/1993) and diagnosed with CRC during follow-up through 2015.
Mortality outcomes were complete through to the end of 2016.
"These findings are important because colorectal cancer patients seek guidance on lifestyle factors to improve their prognosis," said Campbell.
The study also examined the associations of pre- and post- diagnosis use of aspirin and non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) with CRC-specific mortality among CRC survivors.
"While more evidence is needed, preferably from randomised, controlled trials, findings from this study are an important resource to inform clinicians and CRC survivors about the potential benefits and harms of aspirin and non-aspirin NSAIDs use," said Campbell.
Associations of aspirin and non-aspirin non-steroidal anti-inflammatory drugs with colorectal cancer mortality after diagnosis
Figueiredo JC, Jacobs EJ, Newton CC, Guinter MA, Cance WG, Campbell PT
Published in the Journal of the National Cancer Institute on 2 February 2021
Aspirin-use reduces colorectal cancer (CRC) incidence, but there is limited evidence regarding associations of aspirin and non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) with CRC-specific survival.
This prospective analysis includes women and men from the Cancer Prevention Study-II Nutrition Cohort who were cancer-free at baseline (1992 or 1993) and diagnosed with CRC during incidence follow-up through 2015. Detailed information on aspirin and non-aspirin NSAID-use was self-reported on questionnaires at baseline, in 1997, and every 2 years thereafter. Pre- and post-diagnosis data were available for 2,686 and 1,931 participants without distant-metastases, respectively, among whom 512 and 251 died from CRC during mortality follow-up through 2016. Secondary analyses examined associations between pre-diagnosis aspirin-use and stage at diagnosis (distant-metastatic versus localized or regional). All statistical tests were two-sided.
Long-term regular use of aspirin (>15 times per month) before diagnosis was associated with lower CRC-specific mortality (multivariable-adjusted hazard ratio (HR)= 0.69; 95% CI = 0.52–0.92). Post-diagnosis regular aspirin use was not statistically significantly associated with risk of CRC-specific mortality overall (HR = 0.82; 95% CI = 0.62–1.09), although participants who began regular aspirin use only after their diagnosis were at lower risk than participants who did not use aspirin at both the pre-and post-diagnosis periods (HR = 0.60; 95% CI = 0.36–0.98). Long-term aspirin use before diagnosis was also associated with lower odds of diagnosis with distant metastases (multivariable-adjusted odds ratio = 0.73; 95% CI = 0.53–0.99).
Our results suggest that long-term aspirin use before a diagnosis of non-metastatic colorectal cancer may be associated with lower CRC-specific mortality after diagnosis, consistent with possible inhibition of micro-metastases before diagnosis.
JNCI: The Journal of the National Cancer Institute study (Restricted access)
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