Aspirin is a well-known antipyretic and analgesic drug with a long history, born on March 6, 1899, first used to relieve fever and analgesia, and now mostly used to prevent blood clots and other diseases. Recent studies have found that aspirin has been effective in preventing colorectal cancer (CRC).
cancer (CRC) field has made great progress …… So, is aspirin reliable in preventing colorectal cancer? Previous studies have focused on the field of colorectal cancer and the two major effects of aspirin in the field of CRC chemoprevention: (1) reducing the incidence of CRC in healthy people (primary prevention); and (2) reducing tumor recurrence after radical surgery in people with CRC (secondary prevention). There is relatively positive evidence that aspirin-based NSAIDs reduce the incidence of colorectal adenomatous polyps and thus colon cancer. There is also growing evidence in recent years that aspirin, if taken after a diagnosis of CRC, reduces tumor recurrence and improves survival, with the most famous evidence coming from a group led by Andrew
The most famous evidence comes from the findings of a research group led by Andrew CHAN, a prominent scholar at Harvard Massachusetts General Hospital (MGH). They found in 2012 that.
The prevention of recurrence of colon cancer after surgery by aspirin may be associated with mutations in the PIK3CA gene. The results of this study were published in the New England Journal of Medicine that year and sparked a global research boom. More recently, MGH’s CHAN research team has again published a paper establishing the value of aspirin in primary prevention of CRC. They took two of the largest prospective cohort studies in the United States, including the Nurses’ Health Study cohort (NHS, 1980-2010) and the Health Professions Follow-Up Study (HPFS, 1986-2012), which included a total of 135,965 participants, of whom 88,084 were women and 47,881 were men. Value of aspirin in primary prevention of CRC
These observation cases were enrolled in a healthy population without cancer and were originally prospectively observed for the preventive effect of aspirin in cardiovascular disease (CVD), and the incidence of subsequent cancers in this group was now analyzed for a total of 32 years of follow-up. RESULTS: A total of 20414 women and 7571 men developed cancer in the entire cohort. Regular aspirin use (at least 0.5 to 1.5 g of standard aspirin tablets per week) was associated with a 3% reduction in overall cancer risk compared to those who did not take it regularly, with the most significant reduction in CRC risk of 19%. The study also found that aspirin had a preventive effect on other gastrointestinal cancers, but did not reduce the risk of some other common cancers, such as breast, prostate and lung cancers. The study suggests that regular long-term aspirin use significantly reduces the risk of cancer in CRC, giving patients a benefit complementary to screening. Given the value of aspirin for primary prevention of CRC, the U.S. Preventive Services Task
Force (UPSTF) issued specific guidelines on this topic in 2016. After reviewing multiple large randomized controlled studies (RCTs) on the current global cancer prevention effects of aspirin use in primary prevention of CVD, the guidelines found that after a mean of 3.6 to 10.1 years of aspirin use, the overall cancer (all cancers) mortality rate in the study group (10 RGTs, 103,387 total cases, RR=0.96, 95% CI
0.87 to 1.06) and incidence (6 RCTs, total number of cases 72926, RR=0.98, 95% CI
0.93 to 1.04) were not statistically different from those of the control group without regular aspirin use. However, among them, the 20-year mortality rate of CRC was significantly lower in the aspirin group (4 RCTs, RR=0.67, 95% CI
0.52 to 0.86), and a decrease in CRC incidence was found to begin after 10 to 19 years of aspirin administration (3 RCTs, total number of cases 47464, RR=0.60, 95% CI
0.47 to 0.76). The UPSTF recommends in its guidelines that
Adults aged 50 to 59 years without bleeding risk factors and with a life expectancy of 10 years or more should initiate low-dose aspirin therapy and should take it for at least 10 years with the aim of reducing the risk of developing CVD and CRC. Of course, the guidelines also emphasize that the risks and benefits of bleeding and other risks associated with aspirin are difficult to assess accurately and need to be addressed specifically. There have been many recent studies on the value of secondary prevention, and a representative one is the study by the Leiden University School of Medicine in the Netherlands.
A recent study by the Leiden University School of Medicine, publicly reported at the 2015 European Cancer Congress, showed that routine aspirin administration after cancer diagnosis significantly improved survival in patients with cancers originating from the entire GI tract, especially CRC. The study included a total of 13,715 patients with GI cancers registered in the Dutch national health system between 1998 and 2011, and analyzed aspirin only after diagnosis and never taken aspirin in two groups of 9538 patients, mainly CRC (67.7%), but also gastro-esophageal cancer (10.2%) and hepatobiliary systemic cancer and pancreatic cancer; the median follow-up time was 48.6 months. The results showed that patients taking aspirin after cancer diagnosis had an overall 5-year survival rate of 75% and 42%, respectively, compared with those not taking it, with an almost 1-fold improvement in survival. In the analysis by tumor subgroup, it was found that patients with all GI cancers except pancreatic cancer benefited from aspirin, with CRC showing the greatest benefit. Based on the findings of this study, an RCT comparing the value of aspirin in the adjuvant treatment of stage II/III colon cancer has now been initiated in the Netherlands in January 2015. RCT
The ASCOLT study (Clinicaltrial.gov: NCT00565708), led by the National Cancer Centre in Singapore, is one of the most talked about RCTs. The study is for stage II/III CRC who received a minimum of 4 months of 5-Fu-based adjuvant chemotherapy (radiotherapy is not limited) and were randomized to receive aspirin 200 mg/d or placebo for a total of 3 years after the end of standard treatment. The study proposes to enroll more than 1000 patients and has already enrolled more than 2/3 of them, with several centers in China participating in the ASCOLT study. The expectation is that these studies will further answer the question of the value of aspirin in the prevention and treatment of CRC. If confirmed, it will be a milestone development. Can a small aspirin play a big role in cancer prevention and treatment? We’ll see.