Colon Cancer Prevention (cont.)
Dennis Lee, MD
Dennis Lee, MD
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
In this Article
What measures to prevent colorectal 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 colorectal 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 colorectal 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 colorectal 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 colorectal 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 side effects in a healthy person.
Medically Reviewed by a Doctor on 4/28/2014
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