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Randomized Controlled Trial
. 2021 Mar 1;7(3):428-435.
doi: 10.1001/jamaoncol.2020.7338.

Aspirin Use and Risk of Colorectal Cancer Among Older Adults

Chuan-Guo Guo  1   2   3 , Wenjie Ma  1   2   4 , David A Drew  1   2 , Yin Cao  5   6 , Long H Nguyen  1   2   4 , Amit D Joshi  1   2 , Kimmie Ng  7 , Shuji Ogino  8   9   10   11 , Jeffrey A Meyerhardt  7 , Mingyang Song  1   2   8   12 , Wai K Leung  3 , Edward L Giovannucci  8   12   13 , Andrew T Chan  1   2   8   10   13   14
Affiliations
Randomized Controlled Trial

Aspirin Use and Risk of Colorectal Cancer Among Older Adults

Chuan-Guo Guo et al. JAMA Oncol. .

Abstract

Importance: Although aspirin is recommended for the prevention of colorectal cancer (CRC) among adults aged 50 to 59 years, recent data from a randomized clinical trial suggest a lack of benefit and even possible harm among older adults.

Objective: To examine the association between aspirin use and the risk of incident CRC among older adults.

Design, setting, and participants: A pooled analysis was conducted of 2 large US cohort studies, the Nurses' Health Study (June 1, 1980-June 30, 2014) and Health Professionals Follow-up Study (January 1, 1986-January 31, 2014). A total of 94 540 participants aged 70 years or older were included and followed up to June 30, 2014, for women or January 31, 2014, for men. Participants with a diagnosis of any cancer, except nonmelanoma skin cancer, or inflammatory bowel disease were excluded. Statistical analyses were conducted from December 2019 to October 2020.

Main outcomes and measures: Cox proportional hazards models were used to calculate multivariable adjusted hazard ratios (HRs) and 95% CIs for incident CRC.

Results: Among the 94 540 participants (mean [SD] age, 76.4 [4.9] years for women, 77.7 [5.6] years for men; 67 223 women [71.1%]; 65 259 White women [97.1%], 24 915 White men [96.0%]) aged 70 years or older, 1431 incident cases of CRC were documented over 996 463 person-years of follow-up. After adjustment for other risk factors, regular use of aspirin was associated with a significantly lower risk of CRC at or after age 70 years compared with nonregular use (HR, 0.80; 95% CI, 0.72-0.90). However, the inverse association was evident only among aspirin users who initiated aspirin use before age 70 years (HR, 0.80; 95% CI, 0.67-0.95). In contrast, initiating aspirin use at or after 70 years was not significantly associated with a lower risk of CRC (HR, 0.92; 95% CI, 0.76-1.11).

Conclusions and relevance: Initiating aspirin at an older age was not associated with a lower risk of CRC in this pooled analysis of 2 cohort studies. In contrast, those who used aspirin before age 70 years and continued into their 70s or later had a reduced risk of CRC.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Chan reported receiving grants from the National Institutes of Health, the National Cancer Institute, Stand Up to Cancer, and the Crohn's and Colitis Foundation; and personal fees from Bayer Pharma AG, Pfizer Inc, and Boehringer Ingelheim outside of the submitted work. Dr Meyerhardt reported receiving institutional research funding from Boston Biomedical, serving as an advisor and consultant to Ignyta and COTA Healthcare, and serving on a grant review panel for the National Comprehensive Cancer Network funded by Taiho Pharmaceutical outside the submitted work. Dr Leung reported receiving speaker fees from Eisai and Ipsen, an honorarium for attending the advisory board for Janssen and Pfizer, and personal fees from Medtronic and Ferring outside the submitted work. Dr Drew reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Cao reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Ng reported receiving grants from the National Cancer Institute, the Department of Defense, Cancer Research UK, Revolution Medicines, Genentech, and Gilead Sciences; nonfinancial support from Pharmavite and Evergrande Group; and personal fees from Bayer, Seattle Genetics, Array Biopharma, and X-Biotix Therapeutics outside the submitted work. Dr Ogino reported receiving grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Aspirin Initiated at Different Ages and Subsequent Risk of Colorectal Cancer in the Nurses’ Health Study
Multivariable HRs for colorectal cancer of regular use of aspirin initiated at different ages or duration of use vs nonregular users were conditioned on age and calendar time and adjusted for family history of colorectal cancer, diabetes, body mass index, alcohol consumption, physical activity, smoking pack-years, lower endoscopy, total energy intake, calcium intake, folate intake, Alternative Healthy Eating Index 2010 score, and regular use of NSAIDs, multivitamins, and menopausal hormones. Owing to a limited number of participants who initiated aspirin after 80 years of age and used for more than 5 years, separate analysis was not performed. HR indicates hazard ratio; NSAID, nonsteroidal anti-inflammatory drug.
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References

    1. Drew DA, Cao Y, Chan AT. Aspirin and colorectal cancer: the promise of precision chemoprevention. Nat Rev Cancer. 2016;16(3):173-186. doi:10.1038/nrc.2016.4 - DOI - PMC - PubMed
    1. Chapelle N, Martel M, Toes-Zoutendijk E, Barkun AN, Bardou M. Recent advances in clinical practice: colorectal cancer chemoprevention in the average-risk population. Gut. 2020;69(12):2244-2255. doi:10.1136/gutjnl-2020-320990 - DOI - PMC - PubMed
    1. Drew DA, Chan AT. Aspirin in the prevention of colorectal neoplasia. Annu Rev Med. 2020;72. doi:10.1146/annurev-med-060319-120913 - DOI - PMC - PubMed
    1. Bibbins-Domingo K; U.S. Preventive Services Task Force . Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(12):836-845. doi:10.7326/M16-0577 - DOI - PubMed
    1. Flossmann E, Rothwell PM; British Doctors Aspirin Trial and the UK-TIA Aspirin Trial . Effect of aspirin on long-term risk of colorectal cancer: consistent evidence from randomised and observational studies. Lancet. 2007;369(9573):1603-1613. doi:10.1016/S0140-6736(07)60747-8 - DOI - PubMed

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