Aspirin therapy for colorectal cancer prevention: The evidence

Abstract

While the use of aspirin for primary prevention of cardiovascular disease (CVD) has been downplayed recently, its potential role in reducing the risk of certain cancers, most notably colorectal cancer (CRC), has remained of signicant interest. While the use of aspirin for primary prevention of cardiovascular disease (CVD) has been downplayed recently, its potential role in reducing the risk of certain cancers, most notably colorectal cancer (CRC), has remained of signicant interest. More than 135,000 Americans were diagnosed with CRC in 2011.1.www.cdc.gov/cancer/colorectal/statistics/index.htmGoogle Scholar The third most common cancer among American adults, CRC is the second-leading cause of cancer-related death in the United States. Although regular screening for CRC reduces the risk of death, only 58.2% of respondents in a recent National Health Interview Survey indicated some form of screening for this cancer. Screening rates were significantly lower among people without insurance (23.5%) or a regular source of health care (17.8%).2.www.cdc.gov/mmwr/preview/mmwrhtml/mm6417a4.htmGoogle ScholarAs with CVD, patients vary in their individual risk of CRC. Patients with Lynch syndrome (an early-onset hereditary form of CRC), familial adenomatous polyposis (FAP), or inflammatory bowel diseases are at high risk, while many adults are at moderate risk.The evidenceEvidence has supported the long-term use of aspirin 600 mg daily to significantly reduce the risk of CRC in individuals who are carriers for Lynch syndrome.3.www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61049-0/abstractGoogle Scholar Similarly, aspirin may have value in patients with FAP. The benefit of aspirin in reducing risk in patients with inflammatory bowel disease remains unclear.The value of chronic aspirin therapy as a preventive measure in moderate- risk individuals is unknown, and this therapy is unlikely to benefit everyone. Individual genetic differences may be a major contributor in the observed benefits from aspirin.Individuals with an SNP at chromosome 15 have also shown varied responses to aspirin and the development of CRC. An additional report using data from the Nurses’ Health Study and the Health Professionals Follow-up Study indicated a survival advantage among patients taking aspirin 81 mg to 325 mg at least two or more times per week on a regular basis and whose CRC demonstrated a PIK3CA mutation.5.www.nejm.org/doi/pdf/10.1056/NEJMoa1207756Google ScholarFor some individuals at high risk of colorectal cancer, regular use of aspirin may be beneficial, but questions remain, such as optimal dosage and duration of therapy.The U.S. Preventive Services Task Force is sponsoring a systematic review of the available evidence on the role of aspirin for the prevention of CRC. Among their key research questions is whether regular aspirin use reduces the risk of CRC in adults without a history of this cancer, FAP, or Lynch syndrome.The effect of regular aspirin use on total cancer mortality and all-cause mortality also will be assessed. Most important, researchers will try to identify if the benefit is influenced by age, sex, race/ethnicity, and comorbid conditions.What to tell patientsMany lifestyle changes, most notably smoking cessation, can reduce an individual’s risk of different cancers. For some individuals at high risk of CRC, regular use of aspirin may be beneficial, but questions remain, such as optimal dosage and duration of therapy.Encourage patients to discuss their interest in aspirin with their pharmacist and primary care provider so they can carefully consider the risks and benefits of chronic aspirin therapy.Most important, encourage regular screening of your patients for CRC, as early detection most likely has a greater benefit on long-term survival. More than 135,000 Americans were diagnosed with CRC in 2011.1.www.cdc.gov/cancer/colorectal/statistics/index.htmGoogle Scholar The third most common cancer among American adults, CRC is the second-leading cause of cancer-related death in the United States. Although regular screening for CRC reduces the risk of death, only 58.2% of respondents in a recent National Health Interview Survey indicated some form of screening for this cancer. Screening rates were significantly lower among people without insurance (23.5%) or a regular source of health care (17.8%).2.www.cdc.gov/mmwr/preview/mmwrhtml/mm6417a4.htmGoogle Scholar As with CVD, patients vary in their individual risk of CRC. Patients with Lynch syndrome (an early-onset hereditary form of CRC), familial adenomatous polyposis (FAP), or inflammatory bowel diseases are at high risk, while many adults are at moderate risk. The evidenceEvidence has supported the long-term use of aspirin 600 mg daily to significantly reduce the risk of CRC in individuals who are carriers for Lynch syndrome.3.www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61049-0/abstractGoogle Scholar Similarly, aspirin may have value in patients with FAP. The benefit of aspirin in reducing risk in patients with inflammatory bowel disease remains unclear.The value of chronic aspirin therapy as a preventive measure in moderate- risk individuals is unknown, and this therapy is unlikely to benefit everyone. Individual genetic differences may be a major contributor in the observed benefits from aspirin.Individuals with an SNP at chromosome 15 have also shown varied responses to aspirin and the development of CRC. An additional report using data from the Nurses’ Health Study and the Health Professionals Follow-up Study indicated a survival advantage among patients taking aspirin 81 mg to 325 mg at least two or more times per week on a regular basis and whose CRC demonstrated a PIK3CA mutation.5.www.nejm.org/doi/pdf/10.1056/NEJMoa1207756Google ScholarFor some individuals at high risk of colorectal cancer, regular use of aspirin may be beneficial, but questions remain, such as optimal dosage and duration of therapy.The U.S. Preventive Services Task Force is sponsoring a systematic review of the available evidence on the role of aspirin for the prevention of CRC. Among their key research questions is whether regular aspirin use reduces the risk of CRC in adults without a history of this cancer, FAP, or Lynch syndrome.The effect of regular aspirin use on total cancer mortality and all-cause mortality also will be assessed. Most important, researchers will try to identify if the benefit is influenced by age, sex, race/ethnicity, and comorbid conditions. Evidence has supported the long-term use of aspirin 600 mg daily to significantly reduce the risk of CRC in individuals who are carriers for Lynch syndrome.3.www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61049-0/abstractGoogle Scholar Similarly, aspirin may have value in patients with FAP. The benefit of aspirin in reducing risk in patients with inflammatory bowel disease remains unclear. The value of chronic aspirin therapy as a preventive measure in moderate- risk individuals is unknown, and this therapy is unlikely to benefit everyone. Individual genetic differences may be a major contributor in the observed benefits from aspirin. Individuals with an SNP at chromosome 15 have also shown varied responses to aspirin and the development of CRC. An additional report using data from the Nurses’ Health Study and the Health Professionals Follow-up Study indicated a survival advantage among patients taking aspirin 81 mg to 325 mg at least two or more times per week on a regular basis and whose CRC demonstrated a PIK3CA mutation.5.www.nejm.org/doi/pdf/10.1056/NEJMoa1207756Google Scholar For some individuals at high risk of colorectal cancer, regular use of aspirin may be beneficial, but questions remain, such as optimal dosage and duration of therapy. The U.S. Preventive Services Task Force is sponsoring a systematic review of the available evidence on the role of aspirin for the prevention of CRC. Among their key research questions is whether regular aspirin use reduces the risk of CRC in adults without a history of this cancer, FAP, or Lynch syndrome. The effect of regular aspirin use on total cancer mortality and all-cause mortality also will be assessed. Most important, researchers will try to identify if the benefit is influenced by age, sex, race/ethnicity, and comorbid conditions. What to tell patientsMany lifestyle changes, most notably smoking cessation, can reduce an individual’s risk of different cancers. For some individuals at high risk of CRC, regular use of aspirin may be beneficial, but questions remain, such as optimal dosage and duration of therapy.Encourage patients to discuss their interest in aspirin with their pharmacist and primary care provider so they can carefully consider the risks and benefits of chronic aspirin therapy.Most important, encourage regular screening of your patients for CRC, as early detection most likely has a greater benefit on long-term survival. Many lifestyle changes, most notably smoking cessation, can reduce an individual’s risk of different cancers. For some individuals at high risk of CRC, regular use of aspirin may be beneficial, but questions remain, such as optimal dosage and duration of therapy. Encourage patients to discuss their interest in aspirin with their pharmacist and primary care provider so they can carefully consider the risks and benefits of chronic aspirin therapy. Most important, encourage regular screening of your patients for CRC, as early detection most likely has a greater benefit on long-term survival.