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Diabetes, colorectal cancer and cyclooxygenase 2 inhibition

C J Smith1, G A McKay, M Fisher

  • 1Hairmyres Hospital, East Kilbride, UK. chrisjsmith@doctors.org.uk

International Journal of Clinical Practice
|April 1, 2008
PubMed

Insights

Diabetes increases colorectal cancer risk and mortality. While aspirin and NSAIDs may reduce incidence, their side effects and cardiovascular risks limit use, especially in diabetic patients. More intense screening may be needed.

Area of Science:

  • Oncology
  • Endocrinology
  • Gastroenterology

Background:

  • Diabetes mellitus is a significant risk factor for various cancers, including colorectal cancer (CRC).
  • Patients with diabetes exhibit increased cancer-specific mortality.
  • Colorectal cancer chemoprevention strategies are crucial for this high-risk population.

Purpose of the Study:

  • To evaluate the role of anti-inflammatory agents in colorectal cancer prevention for diabetic patients.
  • To assess the risks and benefits of aspirin, NSAIDs, and COX-2 inhibitors in this context.
  • To determine appropriate screening and management strategies for colorectal cancer in individuals with diabetes.

Main Methods:

  • Review of existing literature on diabetes, cancer risk, and chemopreventive agents.
  • Analysis of the mechanisms of action for aspirin, NSAIDs, and COX-2 inhibitors in cancer prevention.
  • Evaluation of the safety profiles of these agents, particularly concerning cardiovascular and gastrointestinal side effects.

Main Results:

  • Diabetes is linked to a higher incidence and mortality of colorectal cancer.
  • Aspirin, NSAIDs, and COX-2 inhibitors show potential in reducing CRC incidence, possibly via prostaglandin inhibition.
  • High-dose aspirin/NSAIDs carry gastrointestinal risks; COX-2 inhibitors increase cardiovascular risks, negating their use in diabetic patients.

Conclusions:

  • The cardiovascular risks associated with COX-2 inhibitors preclude their use for colorectal cancer chemoprophylaxis in diabetic patients.
  • Alternative strategies, such as evaluating low-dose aspirin or implementing intensified colorectal cancer screening programs, are warranted.
  • Healthcare providers must recognize and manage the elevated CRC risk in patients with diabetes, particularly men.

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