Category Archives: Colorectal cancer

ASA, NSAIDs, coxibs and colorectal cancer prevention (Part 5)

intake of NSAIDsThis paper sets the stage for longer term prospective studies. Based on the potential revenue coxibs could generate if proven to prevent cancer, their manufacturers may be able to justify the funding of such trials. Subject recruitment may be largely comprised of patients somewhat younger than those examined in this case-control study, but it is easy to imagine that a multicentre collaboration would be able to enroll sufficient numbers to provide adequate statistical power for such a prospective study. Until then, most of us will still view this class of drugs with cautious respect.

ASA, NSAIDs, coxibs and colorectal cancer prevention (Part 4)

An additional observation made in this study is worthy of comment. The likelihood of finding CRA or CRC was smaller for patients with bowel symptoms, other than bleeding, than for asymptomatic patients, who were presumably investigated for screening purposes rather than for diagnosis. This finding supports the emerging opinion of many experts that, for the assessment of symptoms like chronic abdominal pain or constipation, colonoscopy should not be considered essential, and the choice of investigation should be determined by the individual clinical situation.

ASA, NSAIDs, coxibs and colorectal cancer prevention (Part 3)

celecoxibFor CRC prevention, celecoxib was most effective (OR 0.23), followed by rofecoxib (OR 0.53) and standard NSAIDs (OR 0.67). When data for CRA and CRC were combined, the ORs were 0.47, 0.64 and 0.73 for standard NSAIDs, rofecoxib and celecoxib, respectively. For patients with previous colorectal neoplasia, only rofecoxib was protective (OR 0.43). Insufficient numbers of patients took high dosages of ASA or NSAIDs for at least three months to ascertain either a dose or duration effect.

ASA, NSAIDs, coxibs and colorectal cancer prevention (Part 2)

The paper reviewed here outlines the background and rationale for using these drugs in CRC prevention in the general population. Cox-2 expression is vastly greater in neoplastic tissue than in normal colorectal mucosa. Cox-2 inhibition results in CRC prevention and in CRA prevention and regression in animals, as has been previously reviewed in this Journal and elsewhere . Similar effects have been noted in patients with familial adenomatous polyposis, in whom the role of coxibs is chiefly to retard the development and progression of intestinal neoplasms for which surgery may be deemed inappropriate.

ASA, NSAIDs, coxibs and colorectal cancer prevention (Part 1)

colorectal cancer preventionCRC prevention is increasingly prominent as a public health issue and as a reason for referral to gastroenterologists. Because of our awareness of the adenoma-carcinoma sequence and evidence that adenoma detection by screening reduces CRC incidence and mortality, screening has emerged as the pre-eminent modality of CRC prevention. The resources invested in CRC screening are large and increasing, and have been the subject of a great deal of economic analysis.