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    Home > Active Ingredient News > Digestive System Information > Can aspirin prevent colorectal cancer?

    Can aspirin prevent colorectal cancer?

    • Last Update: 2021-11-16
    • Source: Internet
    • Author: User
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    ▎Data from the International Agency for Research on Cancer (IARC) edited by WuXi AppTec's content team shows that colorectal cancer is already the world's third most common cancer and the second most common cancer in China
    .

    In recent years, a number of studies have shown that aspirin has the potential to prevent colorectal cancer
    .

    However, recently, the United States Preventive Services Task Force (USPSTF) issued relevant draft recommendations.
    After a comprehensive review of the latest existing evidence, it pointed out that "low-dose aspirin has insufficient evidence to reduce the incidence or mortality of colorectal cancer.
    " In terms of the anti-cancer benefits of aspirin There was a question mark
    .

    At present, the USPSTF draft recommendation is still in the open for comments.
    However, in response to this recommendation change, Professor Andrew Chan of the Massachusetts General Hospital (MGH) Cancer Center of Harvard Medical School has a personal opinion
    .

    Professor Andrew Chan pointed out that the evidence for the effectiveness of aspirin in preventing colorectal cancer is still convincing and called for careful revision of related recommendations
    .

    "It is wrong to think directly that aspirin will not be beneficial
    .

    High-risk groups should still discuss (preventive medication) with their doctors, and the scientific community should also conduct further research
    .

    " In today's content, we combine Professor Andrew Chan's discussion and related research progress to share The potential of aspirin in the prevention of colorectal cancer
    .

    What does the USPSTF draft recommendation say? The USPSTF draft recommendation is mainly aimed at aspirin for primary prevention of cardiovascular disease (CVD), but it also analyzes the impact of aspirin on the incidence and death of colorectal cancer in the CVD primary prevention population
    .

    Based on these evidences, the USPSTF pointed out that there are few related studies and the conclusions are not completely consistent
    .

    Four studies conducted in the CVD primary prevention population found that there was no association between taking aspirin and the incidence of colorectal cancer during a follow-up of about 10 years
    .

    Only one women’s health study (WHS, n=39876) reported the long-term effect of aspirin on the risk of morbidity: 17.
    5 years of follow-up data showed that low-dose aspirin was associated with an 18% reduction in the incidence of colorectal cancer; and the latest data showed that this The impact did not last during the follow-up period from 17.
    5 to 26 years
    .

    Two randomized controlled trials reported mortality from colorectal cancer with mixed conclusions
    .

    The ASPREE trial showed that taking aspirin was associated with a 74% increase in the risk of colorectal cancer death at 4.
    7 years of follow-up, while the WHS study did not find a significant increase in colorectal cancer mortality at 10 years
    .

    Two longer-term observational studies have shown that taking low-dose aspirin is associated with reduced mortality from colorectal cancer
    .

    In the thrombosis prevention trial (n=2540), in the 18.
    3 years of observational follow-up, low-dose aspirin was associated with a significant reduction in the risk of death from colorectal cancer by 38%; the data in the observational follow-up part of the WHS study suggested that aspirin and the A 14% reduction in the risk of death from rectal cancer was related but not significant, and this effect was weakened during follow-up from 17.
    5 to 26 years
    .

    Harvard expert: It is difficult to make one size fits all.
    The age and duration of medication are critical.
    Professor Andrew Chan "does not agree with the USPSTF's statement that the benefits of colorectal cancer are inconclusive
    .
    "
    He pointed out that, on the contrary, some recent studies that did not show the benefit of aspirin were short-term clinical trials conducted in specific populations, and the overall data still showed that aspirin is related to the prevention of colorectal cancer
    .

    In addition, a clinical trial last year suggested that aspirin may increase the risk of cancer death in elderly people over 70 years old
    .

    According to Professor Andrew Chan, in the real world, it is not common for people to start taking aspirin after the age of 70
    .

    At the age of 70, many molecular changes in our body that may affect the risk of cancer may have already occurred, and it is not surprising that aspirin can no longer play a positive role
    .

    In fact, the team of Professor Andrew Chan also reported the results of a study in January this year.
    The study showed that if you start taking aspirin at a younger age, you may still benefit from colorectal cancer after the age of 70
    .

    "This shows that whether or not to recommend taking aspirin, you need to consider the age at which you started taking aspirin and how long you have taken it
    .

    Otherwise, it is difficult to make a one-size-fits-all recommendation
    .
    The
    current USPSTF evidence does not explain these subtle differences, but these subtle differences are precisely what Very important
    .

    Oversimplifying the suggestions can confuse people and mistakenly believe that interventions that have the potential to save lives are ineffective in all situations
    .

    "Image source: 123RF Precision Prevention Based on the consideration of subdivided populations, Professor Andrew Chan proposed aspirin.
    " The importance of "precision prevention" is the same as the precision targeted therapy that we have commonly practiced in the field of cancer treatment
    .

    "Aspirin is one of the most important drugs for targeted (preventive) therapy, because it is low-cost, classic and easy to take.
    It has the potential to greatly reduce the personal cancer risk of specific populations.
    However, not everyone can benefit, and we need to weigh the pros and cons
    .

    "Therefore, it is very important to carry out clinical trials of aspirin among young people, especially young people with specific risk factors, to eliminate "information confusion".

    .

    High-risk groups can benefit from taking it as soon as possible.
    In fact, in the past two years, there have been a number of studies that have supported the benefit of aspirin in the "precision prevention" of colorectal cancer in certain high-risk groups
    .

    The seAFOod trial published in The Lancet in 2018 also found that aspirin can reduce the number of precancerous polyps in high-risk groups of adenomas detected by colonoscopy, which is expected to bring additional preventive measures on the basis of colonoscopy
    .

    Other studies have shown the benefits of aspirin in genetically high-risk populations
    .

    In 2020, "The Lancet" will publish an international multi-center trial called CAPP2
    .

    This trial, which started in 1999, used patients with Lynch syndrome as the research object.
    It showed that taking aspirin can reduce the risk of colorectal cancer by half, and the preventive effect can be maintained for up to 10-20 years! In April this year, "The Lancet-Gastroenterology and Hepatology" published a randomized controlled trial.
    In patients with high risk of colorectal cancer-familial adenomatous polyposis (FAP), aspirin significantly reduced colon The risk of polyp recurrence is 63%! If there is no drug prevention option, these patients usually have to undergo preventive total colectomy, otherwise they will almost always develop colorectal cancer before the age of 40
    .

    There are also studies that support the choice of people of a specific age
    .

    Earlier this year, a study led by scholars from Harvard Medical School and published in the Journal of the American Medical Association-Oncology, analyzed the data of about 95,000 people and showed that people who started taking aspirin before the age of 70 and continued to take aspirin after the age of 70 , The risk of colorectal cancer is significantly lower
    .

    In those who take aspirin after 70 years of age, the risk of colorectal cancer is only slightly reduced and not obvious
    .

    Image source: 123RF's future direction Professor Andrew Chan believes that in the future, precision prevention will become a new paradigm for cancer prevention
    .

    "We have seen too many examples of the failure of the one-size-fits-all approach
    .

    Cancer is complex.
    Not everyone gets the same cancer through the same biological pathway
    .

    By identifying specific biomarkers or other molecular factors, we can better predict The benefits and harms of drug prevention
    .

    Ultimately, this is the direction that the field of preventive medicine needs to move forward
    .

    "Related reading "The Lancet" Sub-Journal: 63% less polyp recurrence in high-risk groups, aspirin is expected to prevent colorectal cancer "The Lancet": Aspirin prevents colorectal cancer in high-risk groups, and the effect is up to 10-20 years for primary prevention of aspirin Cardiovascular disease, the applicable population has shrunk? USPSTF new recommendation: ≥60 years old is not recommended to start medication NEJM: Aspirin 40 years of "unsolved problems" usher in important evidence, how to choose the best dose for secondary prevention of cardiovascular disease? NEJM: Aspirin Prevent death from liver cancer and liver disease! 50,000 people study to support the benefit of hepatitis B/C patients.
    Reference materials [1] Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication.
    Retrieved October 15, 2021, from https:// /draft-recommendation/aspirin-use-to-prevent-cardiovascular-disease-preventive-medication[2] New thinking on aspirin and colorectal cancer needs dose of nuance, expert says.
    Retrieved October 27, 2021, from https://news .
    harvard.
    edu/gazette/story/2021/10/revision-of-aspirin-regime-needs-nuanced-approach-says-expert/ Disclaimer: WuXi AppTec's content team focuses on introducing global biomedical health research progress
    .

    This article is only For the purpose of information exchange, the opinions in the article do not represent the position of WuXi AppTec, nor does it mean that WuXi AppTec supports or opposes the views
    in the
    article .
    This article is not a treatment plan recommendation
    .

    If you need guidance on treatment plans, please go to a regular hospital for treatment
    .

    This article is an English version of an article which is originally in the Chinese language on echemi.com and is provided for information purposes only. This website makes no representation or warranty of any kind, either expressed or implied, as to the accuracy, completeness ownership or reliability of the article or any translations thereof. If you have any concerns or complaints relating to the article, please send an email, providing a detailed description of the concern or complaint, to service@echemi.com. A staff member will contact you within 5 working days. Once verified, infringing content will be removed immediately.

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