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Nonsteroidal Anti-Inflammatory Drugs and Cancer Prevention - Landmark Studies

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The contents of this section were published in 2003 as part of SEER's 30th Anniversary celebration.

Numerous studies have provided evidence that nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, may hold promise in helping to prevent cancer. Experimental and epidemiologic (nonrandomized) studies, along with randomized clinical trials, have shown that NSAIDs may have a prophylactic effect against certain cancers. These results have been confirmed in certain colorectal cancers and suggested for other cancer sites.

The idea that NSAIDs might inhibit the occurrence or growth of colorectal cancers was developed in the 1970s and led to a series of animal experiments. Later, randomized clinical trials established that two NSAIDs (sulindac and celecoxib) suppress adenomatous polyps and cause existing polyps to regress in patients with familial adenomatous polyposis (FAP, a rare hereditary condition). Evidence from epidemiologic studies has shown that people who report regular NSAID use have a lower incidence of adenomatous polyps and lower colorectal cancer death rates, indicating a possible protective effect from NSAIDs for the general population. Two recent randomized clinical trials confirm that aspirin suppresses the recurrence of adenomatous polyps in persons with a previous polyp. More limited epidemiologic data show that NSAID use may be associated with lower incidence of or death from cancers at other sites, including the esophagus, stomach, breast, lung, prostate, urinary bladder, and ovary.

Studies are ongoing to determine how NSAIDs may protect against various cancers, possible effects of the long-term use of these drugs, optimum dosages, and contraindications. Benefits and risks of NSAID treatment across a broad range of treatment regimens, outcomes, and patient populations also are being studied.

Selected References

Schreinemachers DM, Everson RB. Aspirin use and lung, colon, and breast cancer incidence in a prospective study. Epidemiology 1994;5(2):138-146.

Castelao JE, Yuan JM, Gago-Dominguez M, Yu MC, Ross RK. Non-steroidal anti-inflammatory drugs and bladder cancer prevention. Br J Cancer 2000;82(7):1364-1369.

Thun MJ, Henley SJ, Patrono C. Nonsteroidal anti-inflammatory drugs as anticancer agents: mechanistic, pharmacologic, and clinical issues. J Natl Cancer Inst 2002;94(4):252-266.

Baron JA, Cole BF, Sandler RS, Haile RW, Ahnen D, Bresalier R, McKeown-Eyssen G, Summers RW, Rothstein R, Burke CA, Snover DC, Church TR, Allen JI, Beach M, Beck GJ, Bond JH, Byers T, Greenberg ER, Mandel JS, Marcon N, Mott LA, Pearson L, Saibil F, van Stolk RU. A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med 2003;348(10):891-899.

Sandler RS, Halabi S, Baron JA, Budinger S, Paskett E, Keresztes R, Petrelli N, Pipas JM, Karp DD, Loprinzi CL, Steinbach G, Schilsky R. A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med 2003;348(10):883-890. Erratum in: N Engl J Med 2003;348(19):1939.

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