Nonsteroidal Anti-Inflammatory Drugs and Cancer Prevention
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.
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