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Reduced Risk for Colorectal Cancer with NSAIDs

Despite strong theoretical models and animal data that support the benefit of nonsteroidal anti-inflammatory drugs (NSAIDs) in reducing the risk for colorectal cancer, clinical studies in humans have been equivocal, and aspirin is the only NSAID for which there are substantial data. This study from Vanderbilt University used Tennessee Medicaid data to assess the relation between prescription NSAID use and colorectal cancer in more than 100,000 people aged 65 or older who had been enrolled for five years or more.

A total of 808 colorectal cancers were identified between 1985 and 1992. NSAID use had no effect on symptoms at diagnosis, such as rectal bleeding or anemia. Compared with nonusers, patients with at least two years of cumulative NSAID use in the prior five years had an adjusted relative risk for cancer of 0.49 (80 vs. 171 cases per 100,000 person-years), whereas those with less than three months of use had no reduction in risk. The protective effect held at all dosages and for all NSAIDs except piroxicam.

Comment: A retrospective study like this one cannot control for such potential sources of bias as over-the-counter NSAID use or prescription compliance, but the powerful protective effect of traditional NSAIDs shown here, and the recent introduction of cyclooxygenase II blockers with fewer side effects, suggest that large prospective studies are in order.

— TL Schwenk

Published in Journal Watch General Medicine February 23, 1999

Citation(s):

Smalley W et al. Use of nonsteroidal anti-inflammatory drugs and incidence of colorectal cancer. Arch Intern Med 1999 Jan 25 159 161-166.

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