Aspirin for the Chemoprevention of Colorectal Adenomas: Meta-analysis of the Randomized Trials

Cole, Bernard F.; Logan, Richard F.; Halabi, Susan; Bénamouzig, Robert; Sandler, Robert S.; Grainge, Matthew J.; Chaussade, Stanislas; Baron, John A.

doi:10.1093/jnci/djn485

Cited by 429 publications

(328 citation statements)

References 24 publications

Supporting

Mentioning

286

Contrasting

Unclassified

Order By: Relevance

“…However, reported adherence rates in clinical trials evaluating aspirin for the prevention of colorectal adenomas are high and range between 76 and 92%. 35 In mutation carriers, aspirin compliance might even be higher because these patients might be aware of their predisposition. Also, like other studies, [12][13][14][15][16]18 ours did not model ongoing adherence rates for CRC prevention.…”

Section: Limitationsmentioning

confidence: 99%

Economic evaluation of genetic screening for Lynch syndrome in Germany

Severin

Stollenwerk

Holinski‐Feder

et al. 2015

Genetics in Medicine

140

View full text Add to dashboard Cite

Purpose: Lynch syndrome (LS) screening among patients with newly diagnosed colorectal cancer can decrease mortality in their affected first-degree relatives. In Germany, it is not yet clinical practice and the cost-effectiveness of different testing strategies is unknown. Methods:We developed a decision-analytic model to analyze the cost-effectiveness of LS screening from the perspective of the German Statutory Health Insurance system. A total of 22 testing strategies considering family-history assessment, analysis of tumor samples (i.e., immunohistochemistry (IHC), microsatellite instability, and BRAF mutation testing) and genetic sequencing were analyzed. Life-years gained in relatives by closedmeshed colonoscopy and aspirin prophylaxis were estimated by Markov models. Uncertainty was assessed deterministically and probabilistically.Results: On average, detected mutation carriers gained 0.52 lifeyears (undiscounted: 1.34) by increased prevention. Most strategies were dominated, with three exceptions: family assessment by the Bethesda criteria followed by IHC and BRAF testing and genetic sequencing; IHC and BRAF testing and genetic sequencing; and direct sequencing of all index patients. Their incremental cost-effectiveness was €77,268, €253,258, and €4,188,036 per life-year gained, respectively. Conclusion:The results were less favorable than those of previous models. Chemoprevention appears to provide comparably low additional benefit and improves cost-effectiveness only slightly.

show abstract

Section: Limitationsmentioning

confidence: 99%

Economic evaluation of genetic screening for Lynch syndrome in Germany

Severin

Stollenwerk

Holinski‐Feder

et al. 2015

Genetics in Medicine

140

View full text Add to dashboard Cite

show abstract

“…(Jemal et al, 2007) It is therefore important to identify aetiological and protective factors for this disease to improve primary prevention. Non-steroidal anti-inflammatory drugs (NSAIDs), especially aspirin, have been reported to reduce the risk of several cancers and some pre-malignant lesions, with risk reductions ranging from 20% to 50% for certain cancer sites (Garcia- Rodriguez and HuertaAlvarez, 2001;Khuder and Mutgi, 2001;Gonzalez-Perez et al, 2003;Abnet et al, 2009;Cole et al, 2009).…”

mentioning

confidence: 99%

Non-steroidal anti-inflammatory drugs and pancreatic cancer risk: a nested case–control study

et al. 2010

View full text Add to dashboard Cite

BACKGROUND: Non-steroidal anti-inflammatory drug (NSAID) use has been linked with pancreatic cancer risk; however, findings from epidemiological studies are inconsistent. METHODS: A nested case -control study was conducted within the UK General Practice Research Database. Cases (n ¼ 1141) had a diagnosis of primary cancer of the exocrine pancreas between January 1995 and June 2006. Controls (n ¼ 7954) were matched with each case on general practice site, sex and year of birth. Conditional logistic regression analyses were used to generate odds ratios (OR) and 95% confidence intervals (CI) associated with NSAID use compared with non-use. RESULTS: Any use of NSAID in the 5 years before the index date or since entry into the database (excluding the year before diagnosis) was not associated with risk of pancreatic cancer; OR 0.96 (95% CI, 0.84 -1.10) and 1.03 (95% CI 0.89 -1.19), respectively. Exposure to NSAIDs for 4 773 days, in the 5 years pre-diagnosis, was associated with a reduced risk of pancreatic cancer OR 0.78 (95%CI 0.62 -0.97). There was evidence of reduced pancreatic cancer risk with long-term use (5 years or more) of lower doses of NSAIDs OR 0.70 (95% CI 0.49 -0.99). CONCLUSION: Long-term exposure to NSAIDs may be associated with a reduction in risk of pancreatic cancer.

show abstract

“…Indomethacin, a cyclooxygenase (COX) inhibitor, suppresses diarrhea as well as the prostaglandin E2 level [16,18]. However, the administration of these drugs is controversial because of their gastrointestinal and cardiovascular side effects [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Prerenal uremia induced by severe diarrhea due to colon adenoma: a case of McKittrick–Wheelock syndrome in an elderly patient

et al. 2013

View full text Add to dashboard Cite

McKittrick-Wheelock syndrome can be successfully treated by emergent dialysis, prescription of bicarbonate, and endoscopic submucosal dissection, which allow elderly people suffering from this syndrome to maintain their activities of daily living. In patients with this syndrome, a large colonic villous adenoma secretes excessive amounts of mucus and causes severe electrolyte depletion and dehydration. An 81-year-old man who had been suffering from chronic renal failure (creatinine 256.4 lmol/L), hypertension, and arrhythmia presented with frequent mucous diarrhea for a month. He was hospitalized for appetite loss, vomiting, general fatigue, and acute renal failure. His blood tests and blood gas analysis revealed urea nitrogen 58.9 mmol/L, creatinine 954.7 lmol/L, pH 7.13, and a base excess of -20.1 mmol/L. Although his symptoms were improved by the emergent dialysis and rehydration, he suffered a relapse only 4 days after he was discharged. At the second admission, a nearcircumferential tumor was found in the rectum by the colonoscopy, which was pathologically confirmed as a villous adenoma. Considering his age and complications, endoscopic submucosal dissection was selected, and internal use of sodium bicarbonate was prescribed. Diarrhea and appetite loss were improved by these treatments, and the creatinine level was also improved to 168.0 lmol/L.

show abstract

Aspirin for the Chemoprevention of Colorectal Adenomas: Meta-analysis of the Randomized Trials

Abstract: Aspirin is effective for the prevention of colorectal adenomas in individuals with a history of these lesions.

Cited by 429 publications

References 24 publications

Economic evaluation of genetic screening for Lynch syndrome in Germany

Economic evaluation of genetic screening for Lynch syndrome in Germany

Non-steroidal anti-inflammatory drugs and pancreatic cancer risk: a nested case–control study

Prerenal uremia induced by severe diarrhea due to colon adenoma: a case of McKittrick–Wheelock syndrome in an elderly patient

Contact Info

Product

Resources

About