Colorectal cancer is the third most common cause of cancer deaths in the US and advanced colorectal polyps are a major risk factor. The US Preventive Services Task Force (USPSTF) concluded that aspirin reduces the risk of colorectal cancer by 40% as well as recurrence of advanced polyps. Their guidelines suggest that, without a specific contra-indication, health care providers should routinely prescribe aspirin to all patients with advanced colorectal polyps.
To explore whether patients are adhering to these USPSTF recommendations and guidelines, researchers from Florida Atlantic University's Schmidt College of Medicine analysed data from structured interviews on 84 patients, ages 40 to 91 years old, with biopsy proven advanced colorectal polyps between 1 July, 2013 to 30 June, 2017.
The data showed that only 36 (42.9%) of the 84 patients with advanced colorectal polyps reported taking aspirin. "These data indicate underutilisation of aspirin to prevent colorectal cancer as well as recurrent polyps in these high-risk patients," said Dr Charles H Hennekens, senior author, the first Sir Richard Doll professor, and senior academic advisor in FAU's Schmidt College of Medicine.
"These data pose major challenges that require multifactorial approaches by clinicians and their patients," said Benjamin Fiedler. "These approaches should include therapeutic lifestyle changes, adjunctive drug therapies as well as screening."
Therapeutic lifestyle changes of proven benefit include avoiding and treating overweight and obesity as well as regular physical activity and adjunctive drug therapies including aspirin.
"By utilising these multifactorial approaches, we believe that these efforts should achieve the most good for the most patients concerning the prevention as well as screening and early diagnosis and treatment of colorectal cancers," said Hennekens, who has done ground-breaking research on the benefits of statins, aspirin, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) as well as beta adrenergic blockers – all of which play major roles in decreasing premature deaths from heart attacks and strokes.
Hennekens was the first to demonstrate that aspirin significantly reduces a first heart attack as well as recurrent heart attacks, strokes, and cardiovascular death when given within 24 hours after onset of symptoms of a heart attack as well as to a wide variety of patients who have survived a blockage in the heart, brain or legs. His landmark and first discoveries on aspirin are not limited to cardiovascular disease and include the prevention of recurrent migraine headaches. He also hypothesised from earlier observational study data that aspirin may decrease risks of colorectal cancer and delay cognitive loss as well as reduce the development of type 2 diabetes.
Since then, randomised trials and their meta-analyses have indicated that aspirin prevents colorectal polyps as well as colorectal cancer.
"More than 90% of patients diagnosed with colorectal cancer are 50 years or older. The major risk factors are similar to those for heart attacks and stroke and include overweight, obesity as well as physical inactivity, a diet low in fibre and high in fat as well as type 2 diabetes," said Dr Lawrence Fiedler.
According to the US Centres for Disease Control and Prevention, additional risk factors include inflammatory bowel disease such as Crohn's disease or ulcerative colitis; a personal or family history of colorectal cancer or colorectal polyps; and a genetic syndrome such as familial adenomatous polyposis or hereditary non-polyposis colorectal cancer (Lynch syndrome).
Background: Colorectal cancer is the third most common cause of cancer deaths in the United States and advanced colorectal polyps are a major risk factor. Although there are no large-scale individual trials designed a priori to test the hypothesis, in meta-analyses of trials in primary prevention of cardiovascular disease aspirin reduces risk of colorectal cancer. The United States Preventive Services Task Force utilized a micro-simulation model including baseline risk factors and concluded that aspirin reduces risk of colorectal cancer by 40%. Their guidelines suggest that, without a specific contraindication, clinicians should routinely prescribe aspirin to patients with advanced colorectal polyps.
Methods: Written informed consent was obtained and brief telephone interviews conducted by trained interviewers for 84 men and women with biopsy proven advanced colorectal polyps from 55 clinical practices.
Results: Of the 84, 39(46.4%) were men. The mean age was 66 with a range from 41 to 91 years. Among the 84, 36 (42.9%) reported taking aspirin.
Conclusions: These data suggest underutilization of aspirin by patients with advanced colorectal polyps. These data pose major challenges requiring multifactorial approaches by clinicians and their patients which include therapeutic lifestyle changes and adjunctive drug therapies as well as screening. Lifestyle changes include avoidance and treatment of overweight and obesity as well as regular physical activity and adjunctive drug therapies include aspirin. These multifactorial approaches will be necessary to achieve the most good for the most patients concerning prevention as well as early diagnosis and treatment of colorectal cancer in patients with advanced colorectal polyps.
Benjamin Fiedler, Lawrence Fiedler, Michael DeDonno, Kosi Anago, Leonie de la Cruz, George R Luck, Charles H Hennekens
[link url="http://www.fau.edu/newsdesk/articles/aspirin-colorectal-cancer.php"]Florida Atlantic University material[/link]
[link url="https://www.amjmed.com/article/S0002-9343(19)30076-2/fulltext"]American Journal of Medicine abstract[/link]