Thursday, August 16

Aspirin for cancer prevention - Aspirin and colorectal cancer

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Uses of aspirin for prevention of cancer in general and colorectal cancer in particular have been examined in recent epidemiological studies. The findings support use of aspirin for colorectal cancer prevention. The exact mechanism of malignant tumor prevention by aspirin is not well understood. Probably by inhibiting prostaglandin synthesis, these non-steroidal anti-inflammatory drugs may be activating immune reactions and inhibiting the synthesis of tumour promoters.

     Aspirin (acetylsalicylic acid) has been in use as an analgesic, antipyretic and anti-inflammatory agent. In low-dose it is recommended for prevention of cardiovascular disease related problems like ischemic stroke or myocardial infarction (heart attack).

Image of colorectal region

Aspirin for cancer prevention

     Research data have shown that daily aspirin may help in prevention of several malignant tumors and the risk of local and distant metastasis.
In two meta-analysis led by Professor Peter Rothwell of the Nuffield Department of Clinical Neurosciences, University of Oxford and his colleagues, published in The Lancet (Volume 379, Issue 9826, Pages 1602 - 1612, 28 April 2012) and The Lancet Oncology (Volume 13, Issue 5, Pages 518 - 527, May 2012) found that regular use of aspirin reduces the long-term risk of several malignant tumors and the risk of distant metastasis; the short-term reductions in malignant tumor incidence and mortality add to the case for daily aspirin in prevention of malignant tumors.

Aspirin for colorectal cancer prevention in Lynch syndrome

     Lynch syndrome (HNPCC) is due to autosomal dominant genetic mutations impairing DNA mismatch repair. Apart from colorectal region Lynch syndrome can affect many of the visceral organs, brain and skin. Individuals with Lynch syndrome have 80% lifetime risk of affliction of colorectal region and 66% of these in the proximal region. Prof Sir John Burn MD and colleagues in their research published in The Lancet (Volume 378, Issue 9809, Pages 2081 - 2087, 17 December 2011) interpreted that "600 mg aspirin per day for a mean of 25 months substantially reduced cancer incidence after 55·7 months in carriers of hereditary colorectal cancer. Further studies are needed to establish the optimum dose and duration of aspirin treatment."

     There are other ways of prevention of these colorectal malignant tumors. It is advised that people above 50 years should get themselves tested for precancerous polyps. If found their surgical removal will help in the avoidance of formation of malignant tumors.

     The epidemiological studies have shown a consistent relationship between aspirin use and colorectal malignant tumor prevention. However various research aspects, like optimum dosage requirements, ideal duration of therapy, risks involved in long-term use and effects on termination of therapy, require further elaborate studies.

     Considering its known side effects like allergies, increased risk of developing hemorrhagic stroke or peptic ulcer disease, aspirin is not suitable for every individual. Only when the benefits of treatment outweigh the risks involved, its use for prevention of colorectal cancer should be considered in individuals prone to aspirin allergies, high blood pressure, ulcers, hemophilia (bleeding disorder) or hemorrhages.


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Aspirin and colorectal cancer prevention

References:
1. Prof Sir John Burn MD et al, Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial, December 2011, doi:10.1016/S0140-6736(11)61049-0

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