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Aspirin to prevent colon cancer is under-utilised in high-risk patients

Colorectal cancer is the third most common cause of cancer deaths in the United States and advanced colorectal polyps are a major risk factor.

The U.S. Preventive Services Task Force (USPSTF) concluded that aspirin reduces the risk of colorectal cancer by 40 percent as well as recurrence of advanced polyps.

Their guidelines suggest that, without a specific contraindication, health care providers should routinely prescribe aspirin to all patients with advanced colorectal polyps.

To explore whether patients are adhering to these USPSTF recommendations and guidelines, researchers analysed data from structured interviews on 84 patients, ages 40 to 91 years old, with biopsy-proven advanced colorectal polyps between July 2013 to June 2017.

The data, which was published in the American Journal of Medicine, showed that only 36 (42.9 percent) of the 84 patients with advanced colorectal polyps reported taking aspirin.

"This data indicates under-utilisation of aspirin to prevent colorectal cancer as well as recurrent polyps in these high-risk patients," said Charles H. Hennekens,  senior author of this study. 

"These data pose major challenges that require multifactorial approaches by clinicians and their patients," said first author, Benjamin Fiedler. "These approaches should include therapeutic lifestyle changes, adjunctive drug therapies as well as screening."

Therapeutic lifestyle changes of proven benefit include avoiding and treating overweight and obesity as well as regular physical activity and adjunctive drug therapies including aspirin.

"By utilising these multifactorial approaches, we believe that these efforts should achieve the best for the most patients concerning the prevention as well as screening and early diagnosis and treatment of colorectal cancers," said Hennekens, who has conducted ground-breaking research on the benefits of statins, aspirin, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and beta-adrenergic blockers.

Hennekens hypothesised from earlier observational study data that aspirin may decrease risks of colorectal cancer and delay cognitive loss as well as reduce the development of type 2 diabetes.

Since then, randomized trials and their meta-analyses have indicated that aspirin prevents colorectal polyps as well as colorectal cancer.

"More than 90 percent of patients diagnosed with colorectal cancer are 50 years or older. The major risk factors are similar to those for heart attacks and stroke and include overweight, obesity as well as physical inactivity, a diet low in fibre and high in fat as well as type 2 diabetes," said Lawrence Fiedler, who is a co-author of this study.

Source: Florida Atlantic University 

 

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