Over the last four decades dozens of epidemiological, clinical and experimental studies have established nonsteroidal anti-inflammatory drugs (NSAIDs) as promising epithelial cancer chemopreventive agents. The long-term use of aspirin and other NSAIDs has been shown to reduce the risk of cancer of the colon and other gastrointestinal organs, as well as cancer of the breast, prostate, lung, and skin. In a recent review, Harris[1] et. al. comprehensively reviewed the published research on NSAIDs and cancer incident. Data from 91 epidemiologic studies were analyzed for the dose response of relative cancer risk and level of NSAID intake for ten prevalent human cancers. The results showed a significant exponential decline in the risk with increasing intake of NSAIDs (primarily aspirin or ibuprofen) for 7 out of the 10 cancers, including the four major types: colon, breast, lung, and prostate cancer. Consistent daily intake of NSAIDs (primarily aspirin), produced risk reductions of 73% for stomach, 69% for esophageal, 63% for colon, 47% for ovarian, 39% for breast and prostate, and 36% for lung! NSAID effects became apparent after five or more years of use and were stronger with longer duration.
Despite general consensus as to the effectiveness of NSAIDs for cancer prevention, unresolved questions with regard to safety, efficacy, optimal treatment regimen, and mechanism of action currently limit the clinical application of NSAIDs to the prevention of cancer. Also, the development of safe and effective NSAIDs for chemoprevention is complicated by the potential that rare, serious toxicity may offset the benefit of treatment with these drugs given to healthy individuals who have a low risk of developing cancer. However, I believe there is growing support for the view that a full understanding of the role of NSAIDs in the prevention and treatment of epithelial cancers will be an integral part of the development of effective future treatments for reducing mortality and morbidity from most cancers.
1. Harris RE, Beebe-Donk J, Doss H, Burr Doss D. Aspirin, ibuprofen, and other non-steroidal anti-inflammatory drugs in cancer prevention: a critical review of non-selective COX-2 blockade (review). Oncol Rep. 2005 Apr;13(4):559-83.
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Until safer NSAIDs are developed, I don't think healthy people should be popping them to prevent cancer.
ReplyDeleteVioxx and Bextra, which are COX-2 inhibitors, are good examples of good intentions turned bad (read the story of NSAIDs here).
How about COX-3? Could it be the answer?
The link between cancer risk and NSAID use is quite interesting. NSAIDs such as low doses of aspirin are already used with some effect in the prevention of cardiovascular disease, although recent evidence suggests that the bulk of the effect is secondary prevention in people who have already had a cardiovascular incident. However there is also evidence that NSAID use, again primarily aspirin, has some effect in lowering risk of Type 2 diabetes, a condition which is increasingly associated with low-grade chronic inflammation, as is obesity. Cancer, CVD and T2DM all have a common risk factor - obesity. Adipose tissue secretes pro-inflammatory cytokines, particularly visceral adipose tissue. Hence it would not surprise me if inflammation did have a pathogenetic role to play.
ReplyDeleteFor primary prevention, especially across the general healthy population, it makes more sense to remove the source of any excess inflammation than to take regular aspirin. However these findings may provide impetus for more active control of even mild inflammation, and add further incentive for healthy lifestyle changes.
Given that some of the more serious side effects of prolonged NSAID use can include kidney failure, liver failure, ulcers and prolonged bleeding post-injury perhaps only people with a high risk of developing these cancers should take NSAIDS as a preventive measure. To me, more important than using drugs to reduce cancer risk is implementing lifestyle changes like not smoking, exercising regularly and eating a healthier diet. Nonetheless, this is an interesting observation that could probably be applied in some cases.
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