Nonsteroidal Anti-inflammatory Drug Use and Risk of Adenomatous and Hyperplastic Polyps

Abstract

Adenomatous polyps are known precursor lesions for colorectal cancer and some hyperplastic polyps also have malignant potential. The use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDS) is associated with a reduced risk of adenomatous polyps; however, less evidence exists regarding NSAID use and hyperplastic polyp risk. We conducted a colonoscopy-based case-control study including 2028 polyp cases (1,529 adenomatous and 499 hyperplastic) and 3,431 polyp-free controls. Multivariate logistic regression models were constructed to derived adjusted odds ratios (OR) and 95% confidence intervals (CI) as the measure of the association between NSAID use and polyp risk. Use of baby aspirin, regular aspirin, and non-aspirin NSAIDs, were associated with a reduced risk of adenomatous polyps (OR = 0.79; 95% CI 0.66–0.93, OR = 0.73; 0.58–0.90, and OR = 0.67; 0.53–0.86, respectively). Baby aspirin was also associated with a reduced risk of hyperplastic polyps (OR = 0.74; 0.56–0.97). Although a dose response was seen with adenoma risk and regular use of any NSAIDs (less than 7 doses per week, 7 doses per week, and greater than 7 doses per week), a dose response was not seen with hyperplastic polyps. We found no evidence of interaction between NSAID dose and duration and polyp risk. The use of any NSAID regardless of type was associated with a reduced risk of adenomatous polyps however regular aspirin and COX-2 inhibitors use was not associated with hyperplastic polyp risk.

Chemoprevention of Colorectal Cancer

“…49 Furthermore, the United Kingdom Colorectal Adenoma Prevention (UKCAP) study showed that aspirin decreased risk of adenoma (relative risk, 0.79; 95% CI, 0.63-0.99) and advanced adenoma (relative risk, 0.63; 95% CI, 0.43-0.91). 50 Similar results were observed in other studies 32,51 and are supported by a meta-analysis. 52 Data from the Nurses' Health Study showed the greatest reduction in adenoma risk for participants who took 14 or more tablets of aspirin per week (relative risk, 0.49; 95% CI, 0.36-0.65).…”

Modifiable lifestyle factors associated with risk of sessile serrated polyps, conventional adenomas and hyperplastic polyps

“…NSAIDs and aspirin use may be an approach for colorectal neoplasia prevention; however, very little is known regarding NSAIDs and their association with SSP risk [10,13,24,25]. A previous study of serrated polyps found an inverse association between aspirin use and serrated polyp risk which was particularly strong for proximal lesions [10].…”

Lifestyle Risk Factors for Serrated Colorectal Polyps: A Systematic Review and Meta-analysis

“…Twelve articles summarising results from one RCT 25 and 11 observational studies 29,30,40,42,44,45,47,50,54,61,62 investigated the risk of SP for individuals taking NSAIDs and/or aspirin, two of which also reported SSA/P risk 29,30 , as outlined in Supplementary Table 1(e). The RCT (which was not included in meta-analyses due to the different study design) demonstrated a significant protective association for right-sided, but not left-sided, SP when taking 81mg or 325mg of aspirin compared with placebo 25 .…”