Colorectal cancer: Aspirin and NSAIDs could reduce the risk of early-onset adenomas

A prospective analysis involving 32,058 women under 50 showed that regular intake, at least twice a week, of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) might lower the risk of early-onset adenomas, particularly those of advanced histology.

Early-onset colorectal cancer is increasingly prevalent, especially among individuals under 50 years. Dr Cassandra Fritz (Washington University School of Medicine, MO, USA) presented a prospective analysis of 32,058 women under 50 who underwent at least 1 lower gastrointestinal endoscopy between 1991 and 2015 [1]. High-risk adenomas were defined as those with a size ≥1 cm, tubulovillous or villous histology, high-grade dysplasia, or by the presence of ≥3 adenomas. As a secondary objective, late-onset adenomas were also evaluated.

Among the 1,247 early-onset adenomas identified, 290 were high-risk. After adjusting results for risk factors (BMI, family history of colorectal cancer, and other comorbidities), regular intake of aspirin or NSAIDs was associated with a lower adenoma risk (OR 0.85; 95% CI 0.75–0.95). This association was held for both high and low-risk adenomas, regardless of size. However, a higher risk reduction was seen for tubulovillous adenomas or those with high-grade dysplasia (OR 0.67; 95% CI 0.51–0.89) compared with tubular adenomas (OR 0.90; 95% CI 0.79–1.03).

For late-onset adenomas, the greatest risk reduction was primarily found in large adenomas (OR 0.76; 95% CI 0.62-0.93) or multiple adenomas (OR 0.57; 95% CI 0.4–0.83) but not in advanced histology adenomas (OR 0.92; 95% CI 0.73–1.17).

The results highlight the urgent need to evaluate aspirin and other NSAIDs as chemopreventive agents for early-onset colorectal cancer. Future studies should consider various patient demographics, appropriate treatment dosage, duration, and potential side effects in young adults.

1. Fritz C, et al. Aspirin and non-steroidal anti-inflammatory drug use and risk of precursors of early-onset colorectal cancer. Lecture 689, DDW 2023, 6–9 May, Chicago, IL, USA.

 

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Posted on 13 June 202317 May 2024