Regular aspirin use and esophageal cancer risk

Abstract

Given the high mortality rate and the rapidly increasing incidence rate of esophageal carcinoma, chemopreventive agents are highly desirable. Aspirin has been shown to be associated with reduced risk of developing colorectal carcinoma and other cancers. Even though previous studies have shown reduced risk of esophageal cancer associated with aspirin use, results were inconsistent with respect to frequency and duration of use. In this hospital-based case-control study, 163 esophageal cancer cases were compared to 482 age-and sex-matched hospital controls with nonneoplastic conditions. Participants were classified as regular aspirin users if they had taken the drug at least once a week for 6 months. Results suggest that esophageal cancer risk is significantly lower for regular aspirin users compared to nonusers [adjusted odds ratio (aOR) 0.54; 95% confidence interval (CI) 0.36-0.86]. Individuals who used an equivalent of at least 1 aspirin a day ( 7 tablets/week) were half as likely to have been diagnosed with esophageal carcinoma (aOR 0.47; 95% CI 0.26-0.85), and a linear trend was noted with increasing frequency of use (p trend 0.007). Similar protective effects were noted with 20 years of use, whereas no risk reduction was noted with >20 years of use. Consistent reduction in risk associated with aspirin use was noted among both the major histological subtypes, but the protective effect appears to be more pronounced in adenocarcinoma compared to squamous cell carcinoma. Overall, results from the current study suggest that regular aspirin use may be associated with reduced risk of esophageal cancer. ' 2006 Wiley-Liss, Inc.Key words: aspirin; esophageal cancer; histology; chemoprevention; epidemiology The American Cancer Society has estimated that 14,520 new cases of esophageal carcinoma will be diagnosed in the United States (US) in 2005. 1 Worldwide, esophageal carcinoma is the 8th most common cancer, responsible for 462,000 new cancer cases in 2002. 2 The 5-year survival rate for esophageal carcinoma was only 14% in US 1 and 10% in Europe, 3 contributing to its position as the cancer with 3rd worse survival rate in the US 1 and as the 6th most deadly cancer throughout the world. 2 There has been a significant increase in the incidence rate of esophageal carcinoma among US males since the 1970s. 4,5 Several other countries have also noted a sharp increases in esophageal carcinoma, and in some regions, the rate has increased more than for any other malignancy. 6,7 Interestingly, the 2 main histological subtypes, squamous cell carcinoma and adenocarcinoma, differ from each other not only by the site of origin, histology, progression and risk factors, [8][9][10][11][12] but also by opposite trends in incidence over last 2 decades. 13-15 While the absolute incidence of squamous cell carcinoma of esophagus fell by one-third, the incidence of adenocarcinoma had a 6-fold increase, which represents the greatest rate of increase among all major malignancies in the US. 16 Thus, in light of increased incidence rates, late...

Aspirin, Nonsteroidal Anti-inflammatory Drugs, and the Risks of Cancers of the Esophagus

“…Among those studies that have examined the association between aspirin or NSAID and risk of esophageal cancer, all but two (7,57) have reported 30% to 50% lower risks of esophageal cancers among people who used NSAIDs compared with never users (44,45,(58)(59)(60)(61)(62). We are aware of only one previous study that has separately measured associations for adenocarcinomas of the esophagus and esophagogastric junction (45).…”

“…Of two studies that have assessed the duration of NSAIDs intake and risk of esophageal adenocarcinoma (10,45), neither observed any association between duration and risk of adenocarcinoma. From five studies that evaluated association between exposure to NSAIDs and risk for any type of esophageal cancer (10,45,47,(58)(59)(60)(61)63), three reported lower risks among people with longer exposure to NSAIDs (59,60,63). The remaining studies had smaller numbers of participants with wide confidence intervals in the longer duration categories, masking possible associations.…”

Non-steroidal anti-inflammatory drugs and risk of gastric and oesophageal adenocarcinomas: results from a cohort study and a meta-analysis

“…We limited our analysis to papers reporting case -control or cohort studies of the association between the use of either aspirin or non-aspirin NSAIDS and the risk of oesophageal or gastric adenocarcinomas. We included the following studies for the oesophagus (Farrow et al, 1998;Cheng et al, 2000;Lindblad et al, 2005;Anderson et al, 2006;Jayaprakash et al, 2006;Ranka et al, 2006;Fortuny et al, 2007;Duan et al, 2008;Sadeghi et al, 2008), cardia (Farrow et al, 1998;Zaridze et al, 1999;Akre et al, 2001;Fortuny et al, 2007;Duan et al, 2008;Sadeghi et al, 2008), non-cardia (Farrow et al, 1998;Zaridze et al, 1999;Akre et al, 2001;Fortuny et al, 2007;Duan et al, 2008), and gastric NOS (Thun et al, 1993;Schreinemachers and Everson, 1994;Coogan et al, 2000;Langman et al, 2000;Akre et al, 2001;Sorensen et al, 2003;Ratnasinghe et al, 2004;Lindblad et al, 2005) and excluded a few studies from certain sections that did not specify the agent (Garidou et al, 1996;Suleiman et al, 2000) or the histology of the oesophageal tumours (Funkhouser and Sharp, 1995;Langman et al, 2000). Two other studies, one prospective and one retrospective, reported on the association between aspirin and oesophageal adenocarcinoma, but included only subjects with Barrett's oesophagus in the reference group (Tsibouris et al, 2004;Vaughan et al, 2005) and these pap...…”

Acetylsalicylic Acid Exhibits Antitumor Effects in Esophageal Adenocarcinoma Cells In Vitro and In Vivo

“…Given at low dose, gastrointestinal toxicity could be minimized by the co-administration of a proton pump inhibitor [8]. Aspirin use has been reported to confer protection against esophageal cancer, showing a 50 % reduction in risk of esophageal carcinoma [9,10]. So far, most evidence on the antitumor effect of aspirin relates to use in prevention rather than treatment.…”