Abstract
In addition to longstanding evidence from observational studies, evidence from randomised trials of the effectiveness of aspirin for chemoprevention of colorectal cancer has increased substantially in recent years. Trials have shown that daily aspirin reduces the risk of any recurrent colorectal adenoma by 17 % and advanced adenoma by 28 %, and that daily aspirin for about 5 years reduces incidence and mortality due to colorectal cancer by 30–40 % after 20 years of follow-up, and reduces the 20-year risk of all-cause cancer mortality by about 20 %. Recent evidence also shows that the risk of major bleeding on aspirin diminishes with prolonged use, suggesting that the balance of risk and benefit favours the use of daily aspirin in primary prevention of colorectal and other cancers. Updated clinical guidelines are currently awaited.
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References
Antithrombotic Trialists’ (ATT) Collaboration, Baigent C, Blackwell L, Collins R, Emberson J, Godwin J et al (2009) Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 373:1849–1860
Atkin WS, Edwards R, Ines K-H, Wooldrage K, Hart AR et al (2010) Once-only flexible sigmoidoscopy in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 375:1624–1633
Baron JA, Cole BF, Sandler RS, Haile RW, Ahnen D, Bresalier R, McKeown-Eyssen G, Summers RW, Rothstein R, Burke CA, Snover DC, Church TR, Allen JI, Beach M, Beck GJ, Bond JH, Byers T, Greenberg ER, Mandel JS, Marcon N, Mott LA, Pearson L, Saibil F, van Stolk RU (2003) A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med 348:891–899
Benamouzig R, Deyra J, Martin A, Girard B, Jullian E, Piednoir B, Couturier D, Coste T, Little J, Chaussade S (2003) Daily soluble aspirin and prevention of colorectal adenoma recurrence: one-year results of the APACC trial. Gastroenterology 125:328–336
Birkenkamp-Demtroder K, Olsen SH, Sorensen FB, Laurberg S et al (2005) Differential gene expression in colon cancer of the caecum versus the sigmoid and rectosigmoid. Gut 54:374–384
Bosetti C, Gallus S, La Vecchia C (2009) Aspirin and cancer risk: a summary review to 2007. Recent Results Cancer Res 181:231–251
Brenner H, Hoffmeister M, Arndt V, Stegmaier C, Altenhofen L, Haug U (2010) Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. J Natl Cancer Inst 102(2):89–95
Brewster D, Muir C, Crichton J (1995) Registration of colorectal cancer in Scotland: an assessment of data accuracy based on review of medical records. Public Health 109:285–292
Brewster DH, Stockton D, Harvey J, Mackay M (2002) Reliability of cancer registration data in Scotland, 1997. Eur J Cancer 38:414–417
Bufill JA (1990) Colorectal cancer: evidence for distinct genetic categories based on proximal or distal tumour location. Ann Intern Med 113:779–788
Chan AT, Giovannucci EL, Meyerhardt JA, Schernhammer ES, Curhan GC, Fuchs CS (2005a) Long-term use of aspirin and nonsteroidal anti-inflammatory drugs and risk of colorectal cancer. JAMA 2(94):914–923
Chan AT, Giovannucci EL, Meyerhardt JA, Schernhammer ES, Wu K, Fuchs CS (2008) Aspirin dose and duration of use and risk of colorectal cancer in men. Gastroenterology 134:21–28
Chan FK, Ching JY, Hung LC, Wong VW, Leung VK, Kung NN, Hui AJ et al (2005b) Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. N Engl J Med 352:238–244
Chapple KS, Cartwright EJ, Hawcroft G, Tisbury A, Bonifer C et al (2000) Localisation of cyclooxygenase-2 in human sporadic colorectal adenomas. Am J Pathol 156:545–553
Charman WN, Charman SA, Monkhouse DC, Frisbee SE, Lockhart EA, Weisman S, Fitzgerald GA (1993) Biopharmaceutical characterisation of a low-dose (75 mg) controlled-release aspirin formulation. Br J ClinPharmacol 36:470–473
Cole BF, Logan RF, Halabi S, Benamouzig R, Sandler RS et al (2009) Aspirin for chemoprevention of colorectal adenomas: meta-analysis of the randomised trials. J Natl Cancer Inst 101:256–266
Cook NR, Lee IM, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE (2005) Low-dose aspirin in the primary prevention of cancer: the women’s health study: a randomized controlled trial. JAMA 294:47–55
Cuzick J, Otto F, Baron JA, Brown PH, Burn J, Greenwald P et al (2009) Aspirin and non-inflammatory drugs for cancer prevention: an international consensus statement. Lancet Oncol 10(5):501–507
Dutch TIA Trial Study Group (1991) A comparison of two doses of aspirin (30 vs 283 mg a day) in patients after a transient ischemic attack or minor ischemic stroke. N Engl J Med 325:1261–1266
Ederer F, Geisser M, Mongin S, Church T, Mandel J (1999) Colorectal cancer deaths as determined by expert committee and from death certificate. Minnesota Stud J ClinEpidemiol 52:447–452
Elwood PC, Gallagher AM, Duthie GG, Mur LA, Morgan G (2009) Aspirin, salicylates, and cancer. Lancet 373:1301–1309
Elsaleh H, Joseph D, Grieu F, Zeps N, Spry N, Iacopetta B (2000) Association of tumour site and sex with survival benefit from adjuvant chemotherapy in colorectal cancer. Lancet 355:1745–1750
Farrell B, Godwin J, Richards S, Warlow C (1991) The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. J NeurolNeurosurg Psychiatry 54:1044–1054
Flossmann E (2007) For the British doctors aspirin trial and the UK-TIA aspirin trial. Effect of aspirin on long-term risk of colorectal cancer: consistent evidence from randomised and observational studies. Lancet 369:1603–1613
Gann PH, Manson JE, Glynn RJ, Buring JE, Hennekens CH (1993) Low-dose aspirin and incidence of colorectal tumors in a randomized trial. J Natl Cancer Inst 85:1220–1224
Garcia Rodriguez LA, Hernandez-Diaz S, de Abajo FJ (2001) Association between aspirin and upper gastrointestinal complications: systematic review of epidemiological studies. Br J Pharmacol 52:563–71
Gorelick PB, Weisman SM (2005) Risk of hemorrhagic stroke with aspirin use: an update. Stroke 36:1801–1807
Hawkins MM, Swerdlow AJ (1992) Completeness of cancer and death follow-up obtained through the National health service central register for England and wales. Br J Cancer 66:408–413
He J, Whelton PK, Vu B, Klag MJ (1998) Aspirin and risk of haemorrhagic stroke: a meta-analysis of randomised controlled trials. JAMA 280:1930–1935
Iacopetta B (2002) Are there two sides to colorectal cancer? Int J Cancer 101:403–408
Jacobs EJ, Thun MJ, Bain EB, Rodriguez C, Henley SJ, Calle EE (2007) A large cohort study of long-term daily use of adult-strength aspirin and cancer incidence. J Natl Cancer Inst 99(8):608–615
Kelloff GJ, Schilsky RL, Alberts DS, Day RW, Guyton KZ, Pearce HL, Peck JC, Phillips R, Sigman CC (2004) Colorectal adenomas: a prototype for the use of surrogate end points in the development of cancer prevention drugs. Clin Cancer Res 1(10):3908–3918
Kozuka S, Nogaki M, Ozeki T, Masumori S (1975) Premalignancy of the mucosal polyp in the large intestine: II estimation of the periods required for malignant transformation of mucosal polyps. Dis Colon Rectum 18:494–500
Kune GA, Kune S, Watson LF (1988) Colorectal cancer risk, chronic illnesses, operations, and medications: case control results from the Melbourne colorectal cancer study. Cancer Res 48:4399–4404
Lai KC, Lam SK, Chu KM, Wong BC, Hui WM, Hu WH, Lau GK et al (2002) Lansoprazole for prevention of recurrences of ulcer complications from long-term low-dose aspirin use. NEJM 346:2033–2038
Lanas A, Fuentes J, Benito R, Serrano P, Bajador E, Sainz R (2002) Helicobacter pylori increases the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin. Aliment Pharmacol Ther 16:779–786
Leopoldo S, Lorena B, Cinzia A, Gabriella DC, Angela Luciana B et al (2008) Two types of mucinous adenocarcinoma of the colorectum: clinicopathological and genetic features. Ann Surg Oncol 15:1429–39
Levine JS, Ahnen DJ (2006) Adenomatous polyps of the colon. N Engl J Med 355:2551–2557
Logan RFA, Grainge MJ, Shepherd VC, Armitage NC, Muir KR (2008) Aspirin and folic acid for the prevention of recurrent colorectal adenomas. Gastroenterology 134:29–38
McIlhatton MA, Tyler J, Burkholder S, Ruschoff J, Rigas B, Kopelovich L, Fishel R (2007) Nitric oxide-donating aspirin derivatives suppress microsatellite instability in mismatch repair-deficient and hereditary nonpolyposis colorectal cancer cells. Cancer Res 67:10966–10975
Medical Research Council’s General Practice Research Framework (1998) Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. Lancet 351:233–241
Morson BC (1984) The evolution of colorectal carcinoma. ClinRadiol 35:425–431
Nasir A, Kaiser HE, Boulware D, Hakam A, Zhao H et al (2004) Cyclooxygenase-2 expression in right- and left-sided colon cancer: a rationale for optimisation of cyclooxygenase-2 inhibitor therapy. Clin Colorectal Cancer 3:243–247
Patrono C, García Rodríguez, Landolfi R, Baigent C (2005) Low-dose aspirin for the prevention of atherothrombosis. N Engl J Med 353:2373–2383
Peto R, Gray R, Collins R, Wheatley K, Hennekens C, Jamrozik K, Warlow C, Hafner B, Thompson E, Norton S (1988) Randomised trial of prophylactic daily aspirin in British male doctors. BMJ 296:313–316
Pollock AM, Vickers N (1995) Reliability of data of the thames cancer registry on 673 cases of colorectal cancer: effect of the registration process. Qual Health Care 4:184–189
Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM (2009) American college of gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroneterol 104:739–750
Robinson MH, Rodrigues VC, Hardcastle JD, Chamberlain JO, Mangham CM, Moss SM (2000) Faecal occult blood screening for colorectal cancer at Nottingham: details of the verification process. J Med Screen 7:97–98
Rothwell PM, Wilson M, Elwin CE, Norrving B, Algra A, Warlow CP, Meade TW (2010) Long-term effect of aspirin on colorectal cancer incidence and mortality: 20 year follow-up of five randomised trials. Lancet 376: 1741–1750
Rothwell PM, Fowkes GR, Belch JJ, Ogawa H, Warlow CP, Meade TW (2011) Long-term effect of aspirin on deaths due to cancer: pooled analysis of data from randomised controlled trials. Lancet 377:31–41
Rothwell PM, Price JF, Fowkes GR, Zanchetti A, Roncaglioni M, Tognoni G, Lee R, Belch JJ, Wilson M, Mehta Z, Meade TW (2012) Short-term effects of daily aspirin on cancer incidence, mortality and non-vascular death: analysis of the time-course of risks and benefits in randomised controlled trials. Lancet (in press)
SALT Collaborative Group (1991) Swedish aspirin low-dose trial (SALT) of 75 mg aspirin as secondary prophylaxis after cerebrovascular ischaemic events. Lancet 338:1345–1349
Sandler RS, Halabi S, Baron JA, Budinger S, Paskett E, Keresztes R, Petrelli N, Pipas JM, Karp DD, Loprinzi CL, Steinbach G, Schilsky R (2003) A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med 348:883–890
Singh H, Nugent Z, Mahmud SM, Demers AA, Bernstein CN (2010) Predictors of colorectal cancer after negative colonoscopy: a population-based study. Am J Gastroenterol 105(3):663–673
Stürmer T, Glynn RJ, Lee IM, Manson JE, Buring JE, Hennekens CH (1998) Aspirin use and colorectal cancer: post-trial follow-up data from the physicians’ health study. Ann Intern Med 128:713–720
Thun MJ, Namboodiri MM, Heath CW (1991) Aspirin use and reduced risk of fatal colon cancer. N Engl J Med 325:1593–1596
Wallace K, Grau MV, Ahnen D, Snover DC, Robertson DJ et al (2009) The association of lifestyle and dietary factors with the risk of serrated polyps of the colorectum. Cancer Epidemiol Biomarkers Prev 18:2310–2317
Weil J, Colin-Jones D, Langman M, Lawson D, Logan R, Murphy M et al (1995) Prophylactic aspirin and risk of peptic ulcer bleeding. BMJ 310:827–830
Weitz J, Koch M, Debus J, Hohler T, Galle PR, Buchler MW (2005) Colorectal cancer. Lancet 365:153–165
Yamauchi M, Morikawa T, Kuchiba A, Imamura Y, Rong Qian Z, Nishihara R, Liao X, Waldron L, Hoshida Y, Huttenhower C, Chan AT, Giovannucci E, Fuchs C, Ogino S (2012) Assessment of colorectal cancer molecular features along bowel subsites challenges the conception of distinct dichotomy of proximal versus distal colorectum Gut. doi:10.1136/gutjnl-2011-300865
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Rothwell, P.M. (2013). Aspirin in Prevention of Sporadic Colorectal Cancer: Current Clinical Evidence and Overall Balance of Risks and Benefits. In: Chan, A., Detering, E. (eds) Prospects for Chemoprevention of Colorectal Neoplasia. Recent Results in Cancer Research, vol 191. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-30331-9_7
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