NSAIDs: Cancer Prevention for Patients with Barrett's Esophagus
November 11, 2005
The study, by Dr Thomas L Vaughan and colleagues, was published in The Lancet Oncology online on 7 November and reported by HealthDay.com on 8 November 2005.
Barrett's esophagus is a precancerous condition that primarily affected Caucasian males aged 50 years and older. The condition it characterized by changes in the esophageal lining that make it resemble intestinal tissue. People who have Barrett's esophagus are 50 times more likely to develop esophageal adenocarcinoma, a type of throat cancer that is the most rapidly increasing cancer in the United States, according to HealthDay.com.
"We observed that people who had Barrett's esophagus who were taking aspirin and other NSAIDs were about a third less likely to go on to get esophageal cancer, compared with people who never took NSAIDs regularly," study author Dr. Thomas L. Vaughan, head of the epidemiology program at Fred Hutchinson Cancer Research Center in Seattle, said to HealthDay.com.
The NSAID category of drugs includes aspirin, ibuprofen and naproxen, as well as the COX-2 inhibitors Vioxx, Bextra and Celebrex. Of the COX-2 inhibitors, only Celebrex is still sold in the US, as Vioxx and Bextra have been withdrawn from the US market.
Vaughan and colleagues studied data form 350 people diagnosed with Barrett's esophagus. Over a period of more than five years, the researchers examined whether there was a correlation between NSAID use by these patients and development of esophageal adenocarcinoma.
The results showed that people with Barrett's esophagus who took NSAIDs had a 68% lower risk of developing esophageal adenocarcinoma than those who did not use NSAIDs. Moreover, for people who had previously taken NSAIDs, the cancer risk was reduced, although by an insignificant amount.
Among study subjects who had never used NSAIDs, the five-year incidence of esophageal adenocarcinoma was 14.3%; among those who had used NSAIDs regularly in the past it was 9.7%; and among people who currently used NSAIDs it was 6.6%.
"I think this is a pretty exciting finding that gives hope to people with Barrett's," Vaughan said to HealthDay.com. "It gives hope that there may be some prevention, because right now there is no medical or surgical treatment that has been shown to reduce risk in those people."
Implications of the Study
"This is an exciting, well-conducted study," said Eric Jacobs, a senior epidemiologist at the American Cancer Society, to HealthDay.com. "If in the future drugs such as aspirin are proven to substantially reduce progression to cancer for people with Barrett's, it could save lives."
However, Jacobs noted that Vaughan et al's trial was only a small, observational study, saying, "We need evidence from randomized clinical trials before we recommend using NSAIDs for cancer prevention in people with Barrett's."
Jacobs advises two things to help prevent esophageal cancer, according to HealthDay.com: "The first is not to smoke, and if you do smoke, quit. The second is to maintain a good body weight and exercise."
Another medical expert believes the study's findings may be valuable in preventing esophageal cancer.
"Esophageal adenocarcinoma in people with Barrett's esophagus is one of the fastest-growing cancers, and if this finding holds up in a larger population it might be very important," said Dr. Peter Barrett, an assistant professor and medical director of the cardiothoracic surgery intensive care unit at Yale University Medical School, according to HealthDay.com.
"If inexpensive medications such as NSAIDs can help prevent esophageal adenocarcinoma, it is certainly very positive news," Barrett reportedly said. "We do know that NSAID use in colorectal cancer helps prevent precancerous polyps. If this would hold up in the esophagus, it would be important."
However, another doctor noted that taking NSAIDs is not without risks.
"Even as the evidence mounts that aspirin and other NSAIDs may lower your likelihood of certain cancers, the well-documented risks of stomach bleeding requires a discussion with your doctor to determine whether the benefits of using these agents is worth the known risks," said Dr A Mark Fendrick, a professor of internal medicine and health management and policy at the University of Michigan, according to HealthDay.com.
Aspirin May Help Prevent Throat Cancer, HealthDay.com/ScoutNews LLC, 8 November 2005.
Non-steroidal anti-inflammatory drugs and risk of neoplastic progression in Barrett's oesophagus: a prospective study, Thomas L Vaughan et al., Lancet Oncology Early Online Publication, 8 November 2005.
Posted: November 2005