Colon/Small Bowel

Subject Category: Colon/Small Bowel

Am J Gastroenterol 2011; 106:1340–1350; doi:10.1038/ajg.2011.38; published online 15 March 2011

Non-Steroidal Anti-Inflammatory Drugs and Colorectal Cancer Risk in a Large, Prospective Cohort

Elizabeth H Ruder PhD, MPH1,2, Adeyinka O Laiyemo MD, MPH3, Barry I Graubard PhD1, Albert R Hollenbeck PhD4, Arthur Schatzkin MD, DrPH1 and Amanda J Cross PhD1

  1. 1Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland, USA
  2. 2Cancer Prevention Fellowship Program, Center for Cancer Training, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland, USA
  3. 3Department of Medicine, Howard University, Washington, District of Columbia, USA
  4. 4AARP, Washington, District of Columbia, USA

Correspondence: Elizabeth H. Ruder, PhD, MPH, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 6120 Executive Boulevard, Rockville, Maryland 20852, USA; E-mail: rudereh@mail.nih.gov

Received 29 September 2010; Accepted 20 January 2011; Published online 15 March 2011.

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Abstract

OBJECTIVES:

 

Use of non-steroidal anti-inflammatory drugs (NSAIDs) has been inversely associated with colorectal cancer; however, the association within colorectal subsites or among higher risk individuals is understudied. We investigated NSAID use and colorectal adenocarcinoma by subsite, and among individuals with a family history of colon cancer in the National Institutes of Health-AARP Diet and Health Study.

METHODS:

 

Using Cox proportional hazards regression, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for colorectal cancer incidence among 301,240 men and women (mean age 62.8 years); including 26,994 individuals with a first-degree relative with a history of colon cancer. We accrued 3,894 colorectal cancer cases during 10 years of follow-up; 372 cases had a first-degree relative with colon cancer.

RESULTS:

 

Both aspirin and non-aspirin NSAID use reduced colorectal cancer risk (HR for users compared with non-users=0.91, 95% CI: 0.85, 0.98; HR=0.82, 95% CI: 0.77, 0.87, respectively). Daily aspirin use reduced the risk of cancer in the distal colon (HR=0.84, 95% CI: 0.71, 0.99) and rectum (HR=0.76, 95% CI: 0.64, 0.90); daily non-aspirin NSAID use reduced the risk of both proximal (HR=0.65, 95% CI: 0.54, 0.78) and distal colon cancer (HR=0.69, 95% CI: 0.55, 0.87), but not rectal cancer. Among participants with a first-degree relative with colon cancer, daily use of aspirin was associated with a decreased risk of rectal cancer (HR=0.38, 95% CI: 0.19, 0.78), and daily use of non-aspirin NSAIDs was associated with a decreased risk of colon cancer (HR=0.49, 95% CI: 0.29, 0.82). No protective benefit for daily aspirin use and colon cancer or daily non-aspirin NSAID use and rectal cancer was observed in this higher risk subgroup, although power was limited by small case numbers.

CONCLUSIONS:

 

NSAID use was associated with a reduced colorectal cancer risk; the magnitude of this association differed between aspirin and non-aspirin NSAIDs. Daily aspirin and non-aspirin NSAID use by individuals with a family history of colon cancer significantly reduced the risk of rectal and colon cancer, respectively.