Protective association of aspirin/NSAIDs and esophageal cancer: A systematic review and meta-analysis

Corley, Douglas A.; Kerlikowske, Karla; Verma, Rajiv; Buffler, Patricia A.

doi:10.1053/gast.2003.50008

Cited by 486 publications

(343 citation statements)

References 61 publications

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“…Patients taking ASA appear less likely to develop esophageal cancer in epidemiological studies ( 140,141 ). In additionally, ASA and nonsteroidal anti-infl ammatory drugs may inhibit several pathways important in oncogenesis.…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,323

1,412

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Recent population studies suggest that gastroesophageal refl ux disease (GERD) is increasing in prevalence, both in the United States and worldwide ( 1,2 ). Th e diagnosis of GERD is associated with a 10-15% risk of Barrett's esophagus (BE), a change of the normal squamous epithelium of the distal esophagus to a columnar-lined intestinal metaplasia (IM). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity ( 3 ), and age over 50 years ( 4,5 ). Th e goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s ( 6,7 ).Th e purpose of this guideline is to review the defi nition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. In order to evaluate the level of evidence and strength of recommendations, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system ( 8 ). Th e level of evidence ranged from "high" (implying that further research was unlikely to change the authors' confi dence in the estimate of the eff ect) to "moderate" (further research would be likely to have an impact on the confi dence in the estimate of eff ect) to "low" (further research would be expected to have an important impact on the confi dence in the estimate of the eff ect and would be likely to change the estimate) or "very low" (any estimate of eff ect is very uncertain). Th e strength of a recommendation was graded as "strong" when the desirable eff ects of an intervention clearly outweighed the undesirable eff ects and as "conditional" when there was uncertainty about the tradeoff s. We used meta-analyses or systematic reviews when available, followed by clinical trials and cohort and case-control studies. In order to determine the level Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with refl ux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-defi nition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is ...

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Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,323

1,412

View full text Add to dashboard Cite

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“…53 Two other systematic reviews with metaanalysis of existing observational studies also showed about 50% reduction in risk of esophageal carcinoma with regular use of aspirin. 54,55 Some of these previous studies have looked at the effect of aspirin/NSAID use on different histological subtypes of esophageal carcinoma. 25,[46][47][48][49] Among these, only 3 studies have looked at the effect of aspirin use on both adenocarcinoma and squamous cell carcinoma in the same population.…”

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confidence: 99%

Regular aspirin use and esophageal cancer risk

Jayaprakash

Menezes

Javle

et al. 2006

Intl Journal of Cancer

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Given the high mortality rate and the rapidly increasing incidence rate of esophageal carcinoma, chemopreventive agents are highly desirable. Aspirin has been shown to be associated with reduced risk of developing colorectal carcinoma and other cancers. Even though previous studies have shown reduced risk of esophageal cancer associated with aspirin use, results were inconsistent with respect to frequency and duration of use. In this hospital-based case-control study, 163 esophageal cancer cases were compared to 482 age-and sex-matched hospital controls with nonneoplastic conditions. Participants were classified as regular aspirin users if they had taken the drug at least once a week for 6 months. Results suggest that esophageal cancer risk is significantly lower for regular aspirin users compared to nonusers [adjusted odds ratio (aOR) 0.54; 95% confidence interval (CI) 0.36-0.86]. Individuals who used an equivalent of at least 1 aspirin a day ( 7 tablets/week) were half as likely to have been diagnosed with esophageal carcinoma (aOR 0.47; 95% CI 0.26-0.85), and a linear trend was noted with increasing frequency of use (p trend 0.007). Similar protective effects were noted with 20 years of use, whereas no risk reduction was noted with >20 years of use. Consistent reduction in risk associated with aspirin use was noted among both the major histological subtypes, but the protective effect appears to be more pronounced in adenocarcinoma compared to squamous cell carcinoma. Overall, results from the current study suggest that regular aspirin use may be associated with reduced risk of esophageal cancer. ' 2006 Wiley-Liss, Inc.Key words: aspirin; esophageal cancer; histology; chemoprevention; epidemiology The American Cancer Society has estimated that 14,520 new cases of esophageal carcinoma will be diagnosed in the United States (US) in 2005. 1 Worldwide, esophageal carcinoma is the 8th most common cancer, responsible for 462,000 new cancer cases in 2002. 2 The 5-year survival rate for esophageal carcinoma was only 14% in US 1 and 10% in Europe, 3 contributing to its position as the cancer with 3rd worse survival rate in the US 1 and as the 6th most deadly cancer throughout the world. 2 There has been a significant increase in the incidence rate of esophageal carcinoma among US males since the 1970s. 4,5 Several other countries have also noted a sharp increases in esophageal carcinoma, and in some regions, the rate has increased more than for any other malignancy. 6,7 Interestingly, the 2 main histological subtypes, squamous cell carcinoma and adenocarcinoma, differ from each other not only by the site of origin, histology, progression and risk factors, [8][9][10][11][12] but also by opposite trends in incidence over last 2 decades. 13-15 While the absolute incidence of squamous cell carcinoma of esophagus fell by one-third, the incidence of adenocarcinoma had a 6-fold increase, which represents the greatest rate of increase among all major malignancies in the US. 16 Thus, in light of increased incidence rates, late...

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“…One chemopreventive approach that has received attention is the regular use of nonsteroidal anti-inflammatory drugs (NSAIDs). It is now generally accepted that NSAIDs prevent the development of colorectal cancer (Kim et al, 2002), and there is some evidence for a protective effect for other types of cancer (Khuder and Mutgi, 2001;Corley et al, 2003). Proposed mechanisms of these effects include induction of apoptosis, inhibition of angiogenesis, and direct inhibition of cellular growth (Kirschenbaum et al, 2001); all occur at least partly through inhibition of the cyclooxygenase (COX) enzymes involved in prostaglandin synthesis.…”

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confidence: 99%

Prostate cancer and use of nonsteroidal anti-inflammatory drugs: systematic review and meta-analysis

2004

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Animal and laboratory studies suggest that regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce prostate cancer risk. To assess this association, we conducted a systematic review and meta-analysis of observational studies published before January 2003. We derived summary odds ratios (ORs) using both fixed and random effects models and performed subgroup analyses to explore the possible sources of heterogeneity between combined studies. We identified 12 reports (five retrospective and seven prospective studies). Most studies of aspirin use reported inverse associations, but only two were statistically significant. The summary OR for the association between aspirin use and prostate cancer was 0.9 (95% confidence interval: 0.82 -0.99; test of homogeneity P ¼ 0.32), and varied from 1.0 for retrospective studies to 0.85 for prospective studies. Studies that measured exposure to a mixture of NSAIDs were less consistent. These results indicate an inverse association between aspirin use and prostate cancer risk. The current epidemiological evidence and, in particular, the strong and consistent laboratory evidence underline the need for additional epidemiological studies to confirm the direction and magnitude of the association.

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Protective association of aspirin/NSAIDs and esophageal cancer: A systematic review and meta-analysis

Cited by 486 publications

References 61 publications

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Regular aspirin use and esophageal cancer risk

Prostate cancer and use of nonsteroidal anti-inflammatory drugs: systematic review and meta-analysis

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