Aspirin, NSAIDs use may reduce risk for early-onset CRC, further study warranted
Click Here to Manage Email Alerts
CHICAGO — The regular use of aspirin and NSAIDs was associated with a lower risk for early-onset adenomas, especially those with advanced histology, according to a researcher at Digestive Disease Week.
“Early-onset colorectal cancer is on the rise,” Cassandra D. L. Fritz, MD, MPHS, assistant professor of gastroenterology at Washington University School of Medicine in St. Louis, said during her presentation. “When you look at trends, specifically for 20- to 49-year-olds, it has been increasing for a number of years, and all stages of disease have been increasing in incidence. When we look at the proportion of early-onset colorectal cancer cases and all newly diagnosed colorectal cancer, this has doubled since 1995 and most early-onset colorectal cancer cases are sporadic.”
She added: “It is also important to know that with this new screening recommendation of age 45, that half of the early-onset colorectal cancer cases are actually diagnosed before the age of 45.”
With previous research indicating that the majority of early-onset CRC originate from conventional adenomas, Fritz and colleagues assessed whether regular use of aspirin and NSAIDs (at least two times/week) could be linked to lower risk for early-onset adenoma, as has been suggested for later-onset CRC.
They conducted a prospective analysis using the Nurses’ Health Study II and identified 32,058 women with at least one lower endoscopy before age 50 years between 1991 and 2015. Of those, 27,018 were not regular aspirin or NSAIDs users and 18,262 were.
Researchers determined that adenomas at least 1 cm or greater in size or with tubulovillous/villous histology or high-grade dysplasia were considered high-risk, as was the presence of three or more adenomas. They also analyzed correlations between later-onset adenomas among women with lower endoscopy at 50 years and older.
Fritz and colleagues identified 1,247 early-onset adenomas, of which 290 were high-risk (n = 185 in no aspirin/NSAIDs use; n = 105 in regular use). After adjusting for risk factors such as BMI, family history of CRC and other comorbidities, researchers determined regular aspirin/NSAIDs use was associated with a lower risk for adenomas (OR = 0.85; 95% CI, 0.75-0.95).
“There was a decreased risk with regular aspirin or NSAIDs use of about 15% for everyone in the population,” Fritz said.
The association was similar for high-risk and low-risk adenomas as well as large and small adenomas, Fritz noted, but was greater for adenomas of tubulovillous/villous histology or with high-grade dysplasia (OR = 0.67; 95% CI, 0.51-0.89) compared with tubular adenomas (OR = 0.9; 95% 0.79-1.03) — a nearly 33% reduced risk. Women without a family history of CRC or symptom indications for endoscopy had similar results.
Findings were similar for later-onset adenomas (overall and high-risk), although the lower risk was primarily observed in large (OR = 0.76; 95% CI, 0.62-0.93) or multiple adenomas (OR = 0.57; 95% CI, 0.4-0.83), but not in adenomas of advanced histology (OR = 0.92; 95% CI, 0.73-1.17).
“Regular aspirin/NSAIDs use was found to be associated with a lower risk of early-onset adenoma, especially those with advanced histology,” Fritz said. “For future directions, we want to evaluate aspirin and NSAIDs as promising agents for chemoprevention in early-onset colorectal cancer.”
She continued, “We need to have gender, racial and ethnic diversity in these studies, and we need to understand dose, duration and side effects in young adults, so we can focus on precision-based strategies.”
Collapse
Fritz CD, et al. Abstract 689: Aspirin and non-steroidal anti-inflammatory drug use and risk of precursors of early-onset colorectal cancer. Presented at: Digestive Disease Week; May 5-9, 2023; Chicago (hybrid meeting).
Read more about
Click Here to Manage Email Alerts