Aspirin and non-steroidal anti-inflammatory drugs for cancer prevention: an international consensus statement.
Evidence clearly shows a chemopreventive effect for aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) on colorectal cancer and probably other cancer types; however, data on the risk-benefit profile for cancer prevention are insufficient and no definitive recommendations can be made. Aspirin has emerged as the most likely NSAID for use in chemoprevention because of its known cardiovascular benefit and available safety and efficacy data. Other traditional NSAIDs, particularly sulindac, and selective COX-2 inhibitors are now given to patients at high risk of colorectal cancer, although these drugs do not provide cardioprotection. More studies of aspirin and cancer prevention are needed to define the lowest effective dose, the age at which to initiate therapy, the optimum treatment duration, and the subpopulations for which the benefits of chemoprevention outweigh the risks of adverse side-effects. Although it might be possible to answer some of these questions with longer follow-up of existing clinical trials, randomised controlled trials with new study designs will be needed. Future projects should investigate the effects of aspirin treatment on multiple organ systems. Cancers of interest are colorectal, breast, prostate, lung, stomach, and oesophageal. The main side-effect of aspirin is peptic ulcers; therefore coadministration of aspirin with a proton-pump inhibitor is an attractive option and is under investigation in the AspECT trial.
Cuzick
Jack
J
Cancer Research UK Centre for Epidemiology, Mathematics, and Statistics, Queen Mary University of London, London UK. j.cuzick@qmul.ac.uk
Otto
Florian
F
Baron
John A
JA
Brown
Powel H
PH
Burn
John
J
Greenwald
Peter
P
Jankowski
Janusz
J
La Vecchia
Carlo
C
Meyskens
Frank
F
Senn
Hans Jörg
HJ
Thun
Michael
M
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000517:prevention & control; D004067:Digestive System Neoplasms / Q000517:prevention & control; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000517:prevention & control; D009369:Neoplasms / Q000517:prevention & control*; D010051:Ovarian Neoplasms / Q000517:prevention & control; D012306:Risk
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin