NSAIDs but not aspirin tied to lower post-colonoscopy colorectal cancer risk

  • Cheung KS & al.
  • Aliment Pharmacol Ther
  • 1 May 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • The use of non-steroidal anti-inflammatory drugs (NSAIDs), but not aspirin, was associated with a reduced risk of post-colonoscopy colorectal cancer (PCCRC) after a negative baseline colonoscopy.

Why this matters

  • Findings highlight the potential chemopreventive effects of NSAIDs on the development of CRC according to the timing of NSAID uses and colonoscopy.

Study design

  • A retrospective cohort study included 187,897 patients with CRC (aged ≥40 years) who underwent colonoscopies between 2005 and 2013.
  • Primary outcome: PCCRC diagnosed between 6 and 36 months (PCCRC-3y).
  • Funding: Health and Medical Research Fund, Food and Health Bureau, The Government of the Hong Kong Special Administrative Region.

Key results

  • Of 187,897 patients with CRC, 21,757 (11.6%) were NSAID users and 166,140 (88.4%) were NSAID non-users.
  • Overall, 854 patients developed PCCRC-3y (distal cancer, 707 [82.8%]; proximal cancer, 147 [17.2%]) with an overall incidence rate of 15.2 per 10,000 person-years.
  • NSAID use was associated with an overall lower risk of PCCRC-3y (adjusted HR [aHR], 0.54; 95% CI, 0.41-0.70), but not with PCCRC >3 years (aHR, 0.78; 95% CI, 0.56-1.09).
  • In the stratified analysis, NSAID use was associated with a reduction in the risk of proximal (aHR, 0.48; 95% CI, 0.24-0.95) and distal colon (aHR, 0.55; 95% CI, 0.40-0.74) cancers.
  • Compared with never user, longer duration vs shorter duration of NSAID use and more frequent (≥weekly) vs infrequent (trend<.001 for both>
  • Aspirin use was not linked to a lower risk of PCCRC-3y (aHR, 1.01; 95% CI, 0.80-1.28).

Limitations

  • Data on some of the risk factors for CRC, like family history and lifestyle factors were unavailable
  • Retrospective design.