Colon Cancer Prevention (cont.)
What measures to prevent colo-rectal cancer probably are effective but may have long
term adverse side effects?
NSAIDs (non-steroidal anti-inflammatory drugs) are widely used in the treatment of
arthritis and other inflammatory conditions of the body. Some examples of NSAIDs
include aspirin, sulindac, ibuprofen, naproxen, and piroxicam. How NSAIDs prevent colon
cancer and polyps is under investigation. (NSAIDs are potent
inhibitors of prostaglandins in the body, and prostaglandins may be important in
the formation of polyps.)
In a 6-year study of approximately 700,000 men and women reported in The New England
Journal of Medicine in 1991 (volume 325, pages 1593-6), the death rates from
colo-rectal cancer were compared between groups with different levels of aspirin
consumption. It was found that adults who consumed aspirin regularly (more than
16 times per month) had a 40% lower death-rate from colo-rectal cancer
than adults who did not consume aspirin regularly.
The most impressive chemoprevention data relate to
sulindac. Ten patients with familial polyposis coli, a genetic disease that
causes individuals to form many colo-rectal cancers, were studied. These
patients had already had their colons removed to prevent colon cancer, but the
distal part of the colon, the rectum, was not removed, and there still were
pre-cancerous polyps in the rectum. Sulindac was found to cause regression (and
sometimes disappearance) of the rectal polyps after 4 months of treatment. The
study was reported in the journal, Gastroenterology, in 1991 (volume 101, pages
635-639). Unfortunately, polyps returned within a few months if sulindac was
stopped or the patient was switched to a placebo.
Why aren't
doctors recommending NSAIDs for colorectal cancer prevention? Because NSAIDs can cause stomach ulcers, intestinal
bleeding and, sometimes, adverse effects on the liver and kidneys. Even though safer NSAIDs
have been developed, doctors generally are reluctant to recommend aspirin or
other NSAIDs for preventing colo-rectal cancer until data on their effectiveness
and long-term safety are available.
When prescribing an agent for
prolonged periods of time to prevent a disease that may or may not occur, the
last thing a doctor would want is for that agent to cause
adverse site effects in a healthy person.
Next: What measures to prevent colo-rectal cancer probably are effective and safe? »
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