Aspirin’s Role in Colorectal Cancer Prevention: New Insights for Unhealthy Lifestyles
TOPLINE:
Recent research has unveiled that aspirin may offer enhanced protection against colorectal cancer (CRC) for individuals leading unhealthy lifestyles, particularly among smokers and those with higher body weight. This revelation opens new avenues for cancer prevention strategies tailored to lifestyle risk factors.
METHODOLOGY:
Aspirin has long been recognized as a preventive agent against colorectal cancer, yet the extent to which individuals with multiple lifestyle risk factors benefit from its use has remained ambiguous. To address this gap, researchers conducted a comprehensive analysis of long-term follow-up data involving 63,957 women from the Nurses’ Health Study and 43,698 men from the Health Professionals Follow-Up Study.
The study defined regular aspirin use as the consumption of two or more standard 325-mg tablets per week. Each participant was assigned a healthy lifestyle score based on several criteria: body mass index (BMI), alcohol intake, physical activity, diet, and smoking habits. Higher scores indicated healthier lifestyles. The researchers then evaluated the 10-year cumulative incidence of CRC, the absolute risk reduction (ARR) associated with aspirin use, and the number needed to treat (NNT) to prevent one case of CRC based on lifestyle scores.
TAKEAWAY:
Over the course of more than three million person-years of follow-up, the study documented 2,544 new cases of colorectal cancer. The findings revealed that the 10-year cumulative incidence of CRC was significantly lower among regular aspirin users, at 1.98%, compared to 2.95% among nonusers. This difference corresponds to an ARR of 0.97%.
Crucially, the ARR associated with aspirin use was most pronounced among individuals with the unhealthiest lifestyle scores, decreasing progressively with healthier lifestyle scores (P < .001 for additive interaction). Specifically, those with the lowest lifestyle scores (0-1) experienced a 10-year ARR of 1.28% from aspirin use, while those with the healthiest scores (4-5) had an ARR of just 0.11%. The NNT to prevent one case of CRC over ten years was 78 for individuals with the unhealthiest lifestyles, compared to 909 for those with healthier lifestyles. Notably, higher BMI and smoking were identified as key factors correlating with greater reductions in CRC risk from aspirin use.
IN PRACTICE:
The authors of the study emphasized the importance of lifestyle risk factors in identifying individuals who may benefit most from aspirin as a preventive measure against cancer. "These results support the use of lifestyle risk factors to identify individuals who may have a more favorable risk-benefit profile for cancer prevention with aspirin," they noted. This insight could lead to more personalized approaches in cancer prevention, focusing on those at higher risk due to their lifestyle choices.
SOURCE:
The study, led by first author Daniel R. Sikavi, MD, from Massachusetts General Hospital and Harvard Medical School in Boston, was published online in JAMA Oncology. The findings contribute significantly to the ongoing discourse surrounding cancer prevention strategies and the role of lifestyle in health outcomes.
LIMITATIONS:
While the study provides valuable insights, it is essential to acknowledge its limitations. The study population primarily consisted of health professionals who were predominantly White, which may restrict the generalizability of the findings to broader populations. Additionally, both lifestyle factors and aspirin use were self-reported, potentially introducing measurement errors. The research did not systematically assess adverse outcomes related to aspirin use or the presence of hereditary cancer syndromes, which could impact the overall risk-benefit analysis.
DISCLOSURES:
The study did not receive any commercial funding, and the authors reported no relevant conflicts of interest. This transparency adds to the credibility of the findings, reinforcing the importance of unbiased research in public health.
In conclusion, the emerging evidence regarding aspirin’s protective effects against colorectal cancer, particularly for those with unhealthy lifestyles, underscores the need for tailored prevention strategies. As we continue to explore the intersection of lifestyle and health, such insights could pave the way for more effective interventions aimed at reducing cancer risk in vulnerable populations.
