Non-Steroidal Anti-Inflammatory Drug Use and Colorectal Polyps in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

Abstract

OBJECTIVES Non-steroidal anti-inflammatory drugs (NSAIDs) have been documented in animal and human studies to reduce risk for colorectal cancer and adenomatous polyps, but risk modification for subgroups of the population and effects on hyperplastic polyps have been less studied. METHODS Data on recent use of two frequently ingested NSAIDs, aspirin and ibuprofen, were collected at baseline from participants aged 55–74 years in the 10 centers of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). Participants randomized to the intervention arm of the trial received a flexible sigmoidoscopy during a baseline examination. Follow-up of detected polyps was accomplished outside the Trial setting and relevant records were sought and abstracted. Cases (n = 4, 017) included subjects with a biopsy-proven polyp in the left side of the colon (descending colon, sigmoid, and rectum) detected as a consequence of PLCO screening; controls (n = 38, 396) were subjects with no left-sided colon polyp. RESULTS Regular use of aspirin (≥ 4 times/month) in the past year was inversely associated with hyperplastic polyps (odds ratios (OR) = 0.8, 95% confidence interval (CI) = 0.7–0.9), adenomatous polyps (OR = 0.8, 95% CI = 0.8–0.9), and advanced adenomas (OR = 0.8, 95% CI = 0.7–0.9). As frequency of aspirin use increased, the prevalence of polyps decreased significantly for each histological classification (P for trend ≤0.0004). Similar patterns were found for adenomas and ibuprofen. Overall protection was consistent in both the descending colon or sigmoid and the rectum, but more evident in males. In males, the OR for heavy use of combined aspirin and ibuprofen (≥ 2 times/day) was 0.6 (95% CI = 0.5–0.8), as opposed to 0.9 (95% CI = 0.8–1.1) in females. The protective effects of NSAIDs for females were apparent only among those with body mass index (BMI) < 25 (OR = 0.8, 95% CI = 0.7–1.0 for regular use of NSAIDs; P interaction = 0.04). We also found a slightly stronger protection of NSAIDs in the 70–74 years age group compared with those aged 55–69 years. CONCLUSIONS This study of a large general risk population supports previous work that recent use of aspirin and ibuprofen is associated with a decreased risk of colorectal adenomas and demonstrates that this protective effect may be stronger in certain population subgroups and is also evident for aspirin and hyperplastic polyps.

Simple Clinical Risk Score Identifies Patients with Serrated Polyps in Routine Practice

“…In the current study, 51.1% of all patients with 1 LPD SP had 1 synchronous adenoma, at a mean (SD) age of 63 (11) years, suggesting that aging may increase the risk for having both LPD SPs and adenomas (19)(20)(21)23). Some previous studies found an association between female gender and presence of serrated polyps (9,39), whereas others, including the current study, did not (40,41).…”

“…Nevertheless, data on risk factors for serrated polyps are still controversial, probably due to large variation between endoscopists in serrated polyp detection (14,15), relatively small number of patients with serrated polyps examined (19,20), inclusion of patients with distal serrated polyps only (18,23), or a predominant male population (21).…”

“…Previous studies identified risk factors associated with an increased risk of having serrated polyps, such as smoking (17)(18)(19)(20)(21)(22), alcohol consumption (20), and obesity (17,19,20,22), whereas daily aspirin and nonsteroidal antiinflammatory drug (NSAID) use seems to be protective (19)(20)(21)(22)(23). Nevertheless, data on risk factors for serrated polyps are still controversial, probably due to large variation between endoscopists in serrated polyp detection (14,15), relatively small number of patients with serrated polyps examined (19,20), inclusion of patients with distal serrated polyps only (18,23), or a predominant male population (21).…”

NSAIDs induce apoptosis in nonproliferating ovarian cancer cells and inhibit tumor growth in vivo

“…Numerous studies demonstrate that nonsteroidal anti-inflammatory drugs (NSAIDs) hold significant promise as anticancer therapeutics (10)(11)(12). Recent data on regular NSAID use indicated a reduction in the incidence of OC and inhibition of carcinogenesis (12)(13)(14)(15).…”

“…Recent data on regular NSAID use indicated a reduction in the incidence of OC and inhibition of carcinogenesis (12)(13)(14)(15). The basic mechanism of action of NSAIDs is to a large part attributed to their inhibition of cycloxygenase 2 (COX-2) (16).…”