BACKGROUND: Aspirin has been associated with a reduced risk of colorectal cancer, and possibly of a few other digestive tract cancers. The quantification of risk reduction and the optimal dose and duration of aspirin use for the prevention of colorectal and other digestive tract cancers remains unclear.
METHODS: To provide an up-to-date quantification of this association, we conducted a systematic review and meta-analysis of all observational studies on aspirin and cancers of the digestive tract sites published through March 2019. We estimated the pooled relative risk (RR) of cancer for regular aspirin use versus non-use using random-effects models, and, whenever data were available, we investigated the dose- and duration-risk relations.
RESULTS: Regular aspirin use is associated with a reduced risk of colorectal cancer [RR = 0.73, 95% confidence interval (CI) = 0.69-0.78, 45 studies], squamous-cell esophageal cancer (RR = 0.67, 95% CI = 0.57-0.79, 13 studies), adenocarcinoma of the esophagus and gastric cardia (RR = 0.61, 95% CI = 0.49-0.77, 10 studies), stomach cancer (RR = 0.64, 95% CI = 0.51-0.82, 14 studies), hepato-biliary tract cancer (RR = 0.62, 95% CI = 0.44-0.86, five studies), and pancreatic cancer (RR = 0.78, 95% CI = 0.68-0.89, 15 studies), but not of head and neck cancer (RR = 0.94, 95% CI = 0.76-1.16, 10 studies). The associations are somewhat stronger in case-control than in cohort and nested case-control studies and are characterized by some between-study heterogeneity. Risk estimates are consistent across sex, geographical areas, and other selected covariates. For colorectal cancer, an aspirin dose between 75 and 100 mg/day conveys a risk reduction of 10%, and a dose of 325 mg/day of 35%. For all neoplasms, except head and neck cancer, inverse duration-risk relations with aspirin use are found.
CONCLUSION: The present comprehensive meta-analysis supports and further quantifies the inverse association between regular aspirin use and the risk of colorectal and other digestive tract cancers, including some rare ones. The favorable effect of aspirin increases with longer duration of use, and, for colorectal cancer, with increasing dose.
There is still insufficient data about the risk-benefit profile about recommending non-aspirin, non-steroidal anti-inflammatory drugs (NA-NSAIDs) for colorectal cancer (CRC) prevention, especially in people aged 40 years or older. This study specifically addressed the association between regular NA-NSAIDs use and CRC risk in the population aged 40 years or older, performing a comprehensive systematic review and meta-analysis of all published studies on this topic until April 2018, by a search of PubMed, Scopus and Web of science databases and clinical trial registries. Two reviewers independently selected studies based on predefined inclusion criteria and assessed study quality using the Newcastle-Otawa scale. The data was combined with the random effects model. Potential heterogeneity was calculated as Q statistic and I2 value. A total of 23 studies involving more than 1 million subjects contributed to the analysis. Pooled odds ratio (OR) of NA-NSAIDs effects on CRC risk was 0.74 (0.67-0.81), I2 = 75.9%, p < 0.001. Heterogeneity was explained by a number of variables including the quality of the studies. Significant protective effects of NA-NSAIDs use were found for women (risk reduction of 19%), higher doses (risk reduction of 18%), distal colon cancer (risk reduction of 22%) and white people (risk reduction from 31% to 41%). From the results NA-NSAIDs use appears to be CRC chemopreventive for a specific subgroup of the population.
BACKGROUND: Epidemiological studies have clarified the potential associations between regular aspirin use and cancers. However, it remains controversial on whether aspirin use decreases the risk of cancers risks. Therefore, we conducted an updated meta-analysis to assess the associations between aspirin use and cancers.
METHODS: The PubMed, Embase, and Web of Science databases were systematically searched up to March 2017 to identify relevant studies. Relative risks (RRs) with 95% confidence intervals (CIs) were used to assess the strength of associations.
RESULTS: A total of 218 studies with 309 reports were eligible for this meta-analysis. Aspirin use was associated with a significant decrease in the risk of overall cancer (RR = 0.89, 95% CI: 0.87-0.91), and gastric (RR = 0.75, 95% CI: 0.65-0.86), esophageal (RR = 0.75, 95% CI: 0.62-0.89), colorectal (RR = 0.79, 95% CI: 0.74-0.85), pancreatic (RR = 0.80, 95% CI: 0.68-0.93), ovarian (RR = 0.89, 95% CI: 0.83-0.95), endometrial (RR = 0.92, 95% CI: 0.85-0.99), breast (RR = 0.92, 95% CI: 0.88-0.96), and prostate (RR = 0.94, 95% CI: 0.90-0.99) cancers, as well as small intestine neuroendocrine tumors (RR = 0.17, 95% CI: 0.05-0.58).
CONCLUSIONS: These findings suggest that aspirin use is associated with a reduced risk of gastric, esophageal, colorectal, pancreatic, ovarian, endometrial, breast, and prostate cancers, and small intestine neuroendocrine tumors.
CONTEXTE: Dans les méta-analyses précédentes, l'utilisation d'aspirine a été associée à un risque réduit de cancer colorectal. Toutefois, l'incertitude demeure sur les relations exactes dose-risque et la durée risque.
MÉTHODES: Nous avons identifié des études en recherchant plusieurs bases de données électroniques anglais et en chinois et en examinant les articles pertinents. La méta-analyse dose-réponse a été effectuée par régression de la tendance linéaire et limité régression spline cubique. Les analyses de sous-groupes ont été réalisées pour étudier les possibilités d'hétérogénéité entre les études. Hétérogénéité potentielle a été calculée en statistique et en valeur. Le biais de publication a été évaluée en utilisant des parcelles d'entonnoir et quantifiée par le Begg et le test de Egger.
RÉSULTATS: Douze études ont été incluses dans cette méta-analyse. Une association inverse entre la consommation d'aspirine et le cancer colorectal a été observée à la fois dans l'ensemble du groupe (RR = 0,74, IC 95% 0,64 à 0,83 pour la dose d'aspirine; RR = 0,80, IC 0,75-0,85 95% de la fréquence d'utilisation de l'aspirine; RR = 0,75 , IC 95% 0,68 à 0,81 pour les années d'utilisation de l'aspirine) et sous-groupes stratifiés selon le sexe et le type de cancer. La méta-analyse dose-réponse a montré qu'il y avait un 20% statistiquement significative diminution du risque de cancer colorectal de 325 mg d'aspirine par incrément d'une journée, 18% du risque de 7 fois l'aspirine par semaine minimum et 18% une diminution du risque de 10 ans aspirine minimum .
CONCLUSION: Long terme (> 5 ans), l'utilisation d'aspirine à faible dose (75-325 mg par jour) et régulière (2-7 fois par semaine) peut réduire efficacement le risque de cancer colorectal.
Aspirin has been associated with a reduced risk of colorectal cancer, and possibly of a few other digestive tract cancers. The quantification of risk reduction and the optimal dose and duration of aspirin use for the prevention of colorectal and other digestive tract cancers remains unclear.
METHODS:
To provide an up-to-date quantification of this association, we conducted a systematic review and meta-analysis of all observational studies on aspirin and cancers of the digestive tract sites published through March 2019. We estimated the pooled relative risk (RR) of cancer for regular aspirin use versus non-use using random-effects models, and, whenever data were available, we investigated the dose- and duration-risk relations.
RESULTS:
Regular aspirin use is associated with a reduced risk of colorectal cancer [RR = 0.73, 95% confidence interval (CI) = 0.69-0.78, 45 studies], squamous-cell esophageal cancer (RR = 0.67, 95% CI = 0.57-0.79, 13 studies), adenocarcinoma of the esophagus and gastric cardia (RR = 0.61, 95% CI = 0.49-0.77, 10 studies), stomach cancer (RR = 0.64, 95% CI = 0.51-0.82, 14 studies), hepato-biliary tract cancer (RR = 0.62, 95% CI = 0.44-0.86, five studies), and pancreatic cancer (RR = 0.78, 95% CI = 0.68-0.89, 15 studies), but not of head and neck cancer (RR = 0.94, 95% CI = 0.76-1.16, 10 studies). The associations are somewhat stronger in case-control than in cohort and nested case-control studies and are characterized by some between-study heterogeneity. Risk estimates are consistent across sex, geographical areas, and other selected covariates. For colorectal cancer, an aspirin dose between 75 and 100 mg/day conveys a risk reduction of 10%, and a dose of 325 mg/day of 35%. For all neoplasms, except head and neck cancer, inverse duration-risk relations with aspirin use are found.
CONCLUSION:
The present comprehensive meta-analysis supports and further quantifies the inverse association between regular aspirin use and the risk of colorectal and other digestive tract cancers, including some rare ones. The favorable effect of aspirin increases with longer duration of use, and, for colorectal cancer, with increasing dose.
