Abstract
BackgroundChemoprevention of colorectal neoplasia with aspirin and statins is under-investigated in Black patients. Since Black patients suffer disproportionately from colon cancer incidence and mortality compared to other populations, we investigated the utility of aspirin and statin in reducing advanced adenomatous polyp (AAP) risk in Black patients.MethodsWe carried out a retrospective cohort study of screening colonoscopies performed at a large urban academic center from 1/1/2011 through 12/31/2019. We analyzed self-identified Black patients with > 1 colonoscopy and no personal history of either inflammatory bowel disease or colon cancer syndromes. Our primary endpoint was first AAP development after index colonoscopy among Black patients taking both aspirin and a statin compared to those taking one or neither medication. We used multivariate logistic regression modeling to investigate our outcomes.ResultsWe found data on chemoprophylaxis use in 560 patients. The mean observation period between index colonoscopy and AAP identification was 4 years. AAP developed in 106/560 (19%) of our cohort. We found no difference in AAP risk among Black patients taking both chemoprevention medications compared to partial or no chemoprophylaxis (20% vs 18% respectively, p = 0.49). This finding remained after adjusting for age, body mass index, and tobacco use (odds ratio 1.04, 95% CI 0.65–1.67; p = 0.87).ConclusionsShort-term aspirin-statin chemoprevention did not reduce the risk of AAP development in our cohort of Black patients. Larger and long-term prospective investigations are needed to investigate the utility of chemoprophylaxis in this population.Trial Registration: Not applicable.
Highlights
Most colorectal cancers (CRCs) are thought to develop from pre-malignant adenomatous polyps [1, 2] with advanced adenomatous polyps (AAP) carrying the highest risk for malignant transformation
We excluded patients with only one colonoscopy on record, a personal history of hereditary polyposis or non-polyposis colon cancer syndromes, a personal history of CRC, CRC found on index colonoscopy, and personal history of inflammatory bowel disease
We found no difference in AAP risk among Black patients taking both chemoprevention medications compared to partial or no chemoprophylaxis (20% vs 18% respectively, p = 0.49). This finding remained after adjusting for age, body mass index (BMI), and tobacco use
Summary
Most colorectal cancers (CRCs) are thought to develop from pre-malignant adenomatous polyps [1, 2] with advanced adenomatous polyps (AAP) carrying the highest risk for malignant transformation. Chemoprevention, known as chemoprophylaxis, aims to reduce CRC incidence by exploiting the effects of different medications on the cell cycle. The role of chemoprevention in reducing the development of high-risk AAP has not been well studied. Our goal was to investigate the utility of aspirin and statins in reducing the risk for developing AAP among Black patients. Chemoprevention of colorectal neoplasia with aspirin and statins is under-investigated in Black patients. Since Black patients suffer disproportionately from colon cancer incidence and mortality compared to other populations, we investigated the utility of aspirin and statin in reducing advanced adenomatous polyp (AAP) risk in Black patients
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