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Nonsteroidal anti-inflammatory drugs and cancer prevention

J A Baron1, R S Sandler

  • 1Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire 03755, USA. John.A.Baron@Dartmouth.edu

Annual Review of Medicine
|April 25, 2000
PubMed

Insights

Nonsteroidal anti-inflammatory drugs (NSAIDs) show anticancer effects in the gastrointestinal tract, reducing colorectal cancer risk. Long-term NSAID use is crucial for this chemopreventive benefit, though mechanisms remain unclear.

Area of Science:

  • Gastroenterology
  • Oncology
  • Pharmacology

Background:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, demonstrate significant anticarcinogenic potential.
  • Epidemiological studies link NSAID use to reduced sporadic colorectal cancer risk.
  • Clinical trials show NSAIDs can regress large bowel adenomas in familial polyposis coli patients.

Purpose of the Study:

  • To review the anticarcinogenic effects of NSAIDs in the gastrointestinal tract.
  • To explore the evidence for NSAID chemoprevention in colorectal, stomach, and esophageal cancers.
  • To discuss potential mechanisms underlying NSAID's anticancer activity.

Main Methods:

  • Review of epidemiological data on NSAID use and cancer risk.
  • Analysis of clinical trial outcomes in patients with gastrointestinal adenomas.
  • Examination of animal studies on NSAID efficacy in experimental carcinogenesis.

Main Results:

  • Consistent inverse association between NSAID use and colorectal cancer risk.
  • Evidence of adenoma regression with NSAID treatment in familial polyposis coli.
  • Long-term NSAID use (15-20 years) appears necessary for reduced colorectal cancer risk.
  • Potential protective effects suggested for stomach and esophageal cancers.

Conclusions:

  • NSAIDs exhibit clinically significant anticarcinogenic effects in the gastrointestinal tract.
  • Sustained, long-term NSAID use is a key factor for observed chemopreventive benefits.
  • Mechanisms of action, including cyclooxygenase-dependent and independent pathways, require further investigation.

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