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Do Older Adults Using NSAIDs Have a Reduced Risk of Colorectal Cancer?

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Abstract

Background and objectives

Colorectal cancer (CRC) is primarily a disease of older adults. Although NSAIDs are thought to protect from CRC, and long-term use of NSAIDs is common in the elderly, little is known about the impact of NSAID use on CRC risk at advanced age. We specifically reviewed current evidence regarding the effects of NSAIDs on CRC risk in individuals aged ≥65 years, a rapidly growing age group.

Study design

We searched all articles in PubMed published before August 2005. Studies were included if a subgroup analysis of older adults (≥65 years of age) was performed, or if long-term use of NSAIDs for ≥5 years and CRC risk was investigated. From the selected studies, relevant information, including sample characteristics and association with CRC risk, was extracted and compared.

Results

Altogether 19 studies were identified. Only four studies specifically considered NSAID use in people ≥65 years of age; of these, two showed risk reduction for CRC comparable to that seen in younger age groups or in all age groups. The most informative observational studies found decreasing relative risk of CRC with increasing duration of NSAID use, suggesting substantial risk reduction after 10–20 years of regular use.

Conclusions

The available data on long-term effects of NSAID use in elderly people are sparse but predominantly indicate risk reduction for CRC comparable to that seen in younger age groups or all ages. Whether and to what degree initiating NSAID use in old age prevents CRC is essentially unknown. In light of the potential adverse effects of NSAIDs, including recent data on adverse cardiovascular outcomes, more information is needed on the minimum effective dose of NSAIDs and the duration of use required in order to evaluate individual risks and benefits in older adults.

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References

  1. Edwards BK, Howe HL, Ries LA, et al. Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on US cancer burden. Cancer 2002; 94(10): 2766–92

    Article  PubMed  Google Scholar 

  2. Wilmoth JR, Deegan LJ, Lundstrom H, et al. Increase of maximum life-span in Sweden, 1861–1999. Science 2000; 289(5488): 2366–8

    Article  PubMed  CAS  Google Scholar 

  3. Boyle P, Leon ME. Epidemiology of colorectal cancer. Br Med Bull 2002; 64: 1–25

    Article  PubMed  Google Scholar 

  4. Vainio H, Miller AB. Primary and secondary prevention in colorectal cancer. Acta Oncol 2003; 42(8): 809–15

    Article  PubMed  Google Scholar 

  5. Ferlay J, Bray F, Pisani P, et al. GLOBOCAN 2000: cancer incidence, mortality and prevalence worldwide, version 1.0. Lyon: IARC Press, 2001

    Google Scholar 

  6. Fuchs CS, Giovannucci EL, Colditz GA, et al. A prospective study of family history and the risk of colorectal cancer. N Engl J Med 1994; 331(25): 1669–74

    Article  PubMed  CAS  Google Scholar 

  7. Enzinger PC, Mayer RJ. Gastrointestinal cancer in older patients. Semin Oncol 2004; 31(2): 206–19

    Article  PubMed  Google Scholar 

  8. de la Chapelle A. Genetic predisposition to colorectal cancer. Nat Rev Cancer 2004; 4(10): 769–80

    Article  PubMed  Google Scholar 

  9. Potter JD. Colorectal cancer: molecules and populations. J Natl Cancer Inst 1999; 91(11): 916–32

    Article  PubMed  CAS  Google Scholar 

  10. Lieberman DA, Prindiville S, Weiss DG, et al. Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals. JAMA 2003; 290(22): 2959–67

    Article  PubMed  Google Scholar 

  11. Herendeen JM, Lindley C. Use of NSAIDs for the chemoprevention of colorectal cancer. Ann Pharmacother 2003; 37(11): 1664–74

    Article  PubMed  CAS  Google Scholar 

  12. Baron JA, Sandler RS. Nonsteroidal anti-inflammatory drugs and cancer prevention. Annu Rev Med 2000; 51: 511–23

    Article  PubMed  CAS  Google Scholar 

  13. Thun MJ, Namboodiri MM, Heath Jr CW. Aspirin use and reduced risk of fatal colon cancer. N Engl J Med 1991; 325(23): 1593–6

    Article  PubMed  CAS  Google Scholar 

  14. Peleg II, Maibach HT, Brown SH, et al. Aspirin and nonsteroidal anti-inflammatory drug use and the risk of subsequent colorectal cancer. Arch Intern Med 1994; 154(4): 394–9

    Article  PubMed  CAS  Google Scholar 

  15. La Vecchia C, Negri E, Franceschi S, et al. Aspirin and colorectal cancer. Br J Cancer 1997; 76(5): 675–7

    Article  PubMed  Google Scholar 

  16. Coogan PF, Rosenberg L, Louik C, et al. NSAIDs and risk of colorectal cancer according to presence or absence of family history of the disease. Cancer Causes Control 2000; 11(3): 249–55

    Article  PubMed  CAS  Google Scholar 

  17. Meier CR, Schmitz S, Jick H. Association between acetaminophen or nonsteroidal antiinflammatory drugs and risk of developing ovarian, breast, or colon cancer. Pharmacotherapy 2002; 22(3): 303–9

    Article  PubMed  CAS  Google Scholar 

  18. Juarranz M, Calle-Puron ME, Gonzalez-Navarro A, et al. Physical exercise, use of Plantago ovata and aspirin, and reduced risk of colon cancer. Eur J Cancer Prev 2002; 11(5): 465–72

    Article  PubMed  CAS  Google Scholar 

  19. Benedetti AL, Collet JP, Boivin JF, et al. Effect of nonsteroidal anti-inflammatory drugs on stage of colon cancer at diagnosis. J Clin Epidemiol 2003; 56(8): 782–7

    Article  PubMed  Google Scholar 

  20. Gridley G, McLaughlin JK, Ekbom A, et al. Incidence of cancer among patients with rheumatoid arthritis. J Natl Cancer Inst 1993; 85(4): 307–11

    Article  PubMed  CAS  Google Scholar 

  21. Muller AD, Sonnenberg A, Wasserman IH. Diseases preceding colon cancer: a case-control study among veterans. Dig Dis Sci 1994; 39(11): 2480–4

    Article  PubMed  CAS  Google Scholar 

  22. Kauppi M, Pukkala E, Isomaki H. Low incidence of colorectal cancer in patients with rheumatoid arthritis. Clin Exp Rheumatol 1996; 14(5): 551–3

    PubMed  CAS  Google Scholar 

  23. Cibere J, Sibley J, Haga M. Rheumatoid arthritis and the risk of malignancy. Arthritis Rheum 1997; 40(9): 1580–6

    Article  PubMed  CAS  Google Scholar 

  24. Schreinemachers DM, Everson RB. Aspirin use and lung, colon, and breast cancer incidence in a prospective study. Epidemiology 1994; 5(2): 138–46

    Article  PubMed  CAS  Google Scholar 

  25. Giovannucci E, Rimm EB, Stampfer MJ, et al. Aspirin use and the risk for colorectal cancer and adenoma in male health professionals. Ann Intern Med 1994; 121(4): 241–6

    PubMed  CAS  Google Scholar 

  26. Muscat JE, Stellman SD, Wynder EL. Nonsteroidal antiinflammatory drugs and colorectal cancer. Cancer 1994; 74(7): 1847–54

    Article  PubMed  CAS  Google Scholar 

  27. Paganini-Hill A. Aspirin and colorectal cancer: the Leisure World cohort revisited. Prev Med 1995; 24(2): 113–5

    Article  PubMed  CAS  Google Scholar 

  28. Giovannucci E, Egan KM, Hunter DJ, et al. Aspirin and the risk of colorectal cancer in women. N Engl J Med 1995; 333(10): 609–14

    Article  PubMed  CAS  Google Scholar 

  29. Peleg II, Lubin MF, Cotsonis GA, et al. Long-term use of nonsteroidal antiinflammatory drugs and other chemopreventors and risk of subsequent colorectal neoplasia. Dig Dis Sci 1996; 41(7): 1319–26

    Article  PubMed  CAS  Google Scholar 

  30. Reeves MJ, Newcomb PA, Trentham-Dietz A, et al. Nonsteroidal anti-inflammatory drug use and protection against colorectal cancer in women. Cancer Epidemiol Biomarkers Prev 1996; 5(12): 955–60

    PubMed  CAS  Google Scholar 

  31. Freedman AN, Michalek AM, Weiss HA, et al. Aspirin use and p53 expression in colorectal cancer. Cancer Detect Prev 1998; 22(3): 213–8

    Article  PubMed  CAS  Google Scholar 

  32. Sturmer T, Glynn RJ, Lee IM, et al. Aspirin use and colorectal cancer: post-trial follow-up data from the Physicians’ Health Study. Ann Intern Med 1998; 128(9): 713–20

    PubMed  CAS  Google Scholar 

  33. Smalley W, Ray WA, Daugherty J, et al. Use of nonsteroidal anti-inflammatory drugs and incidence of colorectal cancer: a population-based study. Arch Intern Med 1999; 159(2): 161–6

    Article  PubMed  CAS  Google Scholar 

  34. Garcia-Rodriguez LA, Huerta-Alvarez C. Reduced risk of colorectal cancer among long-term users of aspirin and nonaspirin nonsteroidal antiinflammatory drugs. Epidemiology 2001; 12(1): 88–93

    Article  PubMed  CAS  Google Scholar 

  35. Cook NR, Lee IM, Gaziano JM, et al. Low-dose aspirin in the primary prevention of cancer: the Women’s Health Study: a randomized controlled trial. JAMA 2005; 294(1): 47–55

    Article  PubMed  CAS  Google Scholar 

  36. Chan AT, Giovannucci EL, Meyerhardt JA, et al. Long-term use of aspirin and nonsteroidal anti-inflammatory drugs and risk of colorectal cancer. JAMA 2005; 294(8): 914–23

    Article  PubMed  CAS  Google Scholar 

  37. Rosenberg L, Palmer JR, Zauber AG, et al. A hypothesis: nonsteroidal anti-inflammatory drugs reduce the incidence of large-bowel cancer. J Natl Cancer Inst 1991; 83(5): 355–8

    Article  PubMed  CAS  Google Scholar 

  38. Thun MJ, Namboodiri MM, Calle EE, et al. Aspirin use and risk of fatal cancer. Cancer Res 1993; 53(6): 1322–7

    PubMed  CAS  Google Scholar 

  39. Gann PH, Manson JE, Glynn RJ, et al. Low-dose aspirin and incidence of colorectal tumors in a randomized trial. J Natl Cancer Inst 1993; 85(15): 1220–4

    Article  PubMed  CAS  Google Scholar 

  40. Rosenberg L, Louik C, Shapiro S. Nonsteroidal antiinflammatory drug use and reduced risk of large bowel carcinoma. Cancer 1998; 82(12): 2326–33

    Article  PubMed  CAS  Google Scholar 

  41. Collet JP, Sharpe C, Belzile E, et al. Colorectal cancer prevention by non-steroidal anti-inflammatory drugs: effects of dosage and timing. Br J Cancer 1999; 81(1): 62–8

    Article  PubMed  CAS  Google Scholar 

  42. Friis S, Sorensen HT, McLaughlin JK, et al. A population-based cohort study of the risk of colorectal and other cancers among users of low-dose aspirin. Br J Cancer 2003; 88(5): 684–8

    Article  PubMed  CAS  Google Scholar 

  43. Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med 1999; 340(24): 1888–99

    Article  PubMed  CAS  Google Scholar 

  44. Berger JS, Roncaglioni MC, Avanzini F, et al. Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials. JAMA 2006; 295(3): 306–13

    Article  PubMed  CAS  Google Scholar 

  45. Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective COX-2 inhibitors. JAMA 2001; 286(8): 954–9

    Article  PubMed  CAS  Google Scholar 

  46. Graham DJ, Campen D, Hui R, et al. Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclo-oxygenase 2 selective and non-selective non-steroidal anti-inflammatory drugs: nested case-control study. Lancet 2005; 365(9458): 475–81

    PubMed  CAS  Google Scholar 

  47. Fitzgerald GA. Coxibs and cardiovascular disease. N Engl J Med 2004; 351(17): 1709–11

    Article  PubMed  CAS  Google Scholar 

  48. Hippisley-Cox J, Coupland C. Risk of myocardial infarction in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis. BMJ 2005; 330(7504): 1366–9

    Article  PubMed  CAS  Google Scholar 

  49. Hudson M, Richard H, Pilote L. Differences in outcomes of patients with congestive heart failure prescribed celecoxib, rofecoxib, or non-steroidal anti-inflammatory drugs: population based study. BMJ 2005; 330(7504): 1370–3

    Article  PubMed  CAS  Google Scholar 

  50. Ridker PM, Cook NR, Lee IM, et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 2005; 352(13): 1293–304

    Article  PubMed  CAS  Google Scholar 

  51. Baron JA, Cole BF, Sandler RS, et al. A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med 2003; 348(10): 891–9

    Article  PubMed  CAS  Google Scholar 

  52. Sandler RS, Halabi S, Baron JA, et al. A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Engl J Med 2003; 348(10): 883–90

    Article  PubMed  CAS  Google Scholar 

  53. Hernandez-Diaz S, Rodriguez LA. Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the 1990s. Arch Intern Med 2000; 160(14): 2093–9

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

No sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article.

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Authors and Affiliations

  1. Department of Epidemiology, German Centre for Research on Ageing (DZFA), Heidelberg, Germany

    Michael Hoffmeister &  Hermann Brenner

  2. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Bergheimer Strasse 20, Heidelberg, D-69115, Germany

    Michael Hoffmeister &  Hermann Brenner

  3. Unit of Genetic Epidemiology, Division of Clinical Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Jenny Chang-Claude

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  1. Michael Hoffmeister
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Correspondence to Hermann Brenner.

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Hoffmeister, M., Chang-Claude, J. & Brenner, H. Do Older Adults Using NSAIDs Have a Reduced Risk of Colorectal Cancer?. Drugs Aging 23, 513–523 (2006). https://doi.org/10.2165/00002512-200623060-00006

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