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Aspirin Prophylaxis for Colon Cancer: Not Good Enough

Although screening decreases colorectal cancer incidence and colorectal-cancer-specific mortality rates, many patients do not get screened. Results from observational studies suggest that aspirin reduces risk for colorectal cancer. To evaluate the cost-effectiveness of aspirin prophylaxis, researchers used a decision-analytic model to compare no screening plus no aspirin, aspirin alone, sigmoidoscopy plus fecal occult blood testing (FOBT), colonoscopy, and aspirin plus screening tests in adults (age, 50 to 80).

Compared with no aspirin plus no screening, aspirin alone would result in fewer cases of colorectal cancer. Screening with sigmoidoscopy and FOBT would decrease the incidence further, as would colonoscopy. Combining aspirin and screening tests would decrease the incidence further still. Adding screening tests to aspirin was cost-effective ($26,000 to $31,000 per life-year gained). However, adding aspirin to sigmoidoscopy and FOBT was less effective (due to aspirin-related deaths) and more costly than were the tests alone; adding aspirin to colonoscopy was not cost-effective ($149,000 per life-year gained). Results of the analysis were very sensitive to changes in assumptions about aspirin's effects.

Comment: Nonsteroidal anti-inflammatory drugs hold some promise for preventing colorectal cancer, particularly because adherence to them may be better than adherence to recommended screening strategies. However, NSAIDs currently cannot be recommended, because risks and costs may outweigh benefits. For now, the focus should remain on encouraging adherence to fecal occult blood testing, sigmoidoscopy, and colonoscopy.

— R Saitz

Published in Journal Watch General Medicine November 13, 2001

Citation(s):

Ladabaum U et al. Aspirin as an adjunct to screening for prevention of sporadic colorectal cancer: A cost-effectiveness analysis. Ann Intern Med 2001 Nov 6 135 769-781.

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