Effect of aspirin on long-term risk of colorectal cancer: consistent evidence from randomised and observational studies
Abstract
Background Randomised trials have shown that aspirin reduces the short-term risk of recurrent colorectal adenomas in patients with a history of adenomas or cancer, but large trials have shown no effect in primary prevention of colorectal cancer during 10 years' follow-up. However, the delay from the early development of adenoma to presentation with cancer is at least 10 years. We aimed to assess the longer-term effect of aspirin on the incidence of cancers. Methods We studied the effect of aspirin in two large randomised trials with reliable post-trial follow-up for more than 20 years: the British Doctors Aspirin Trial (N=5139, two-thirds allocated 500 mg aspirin for 5 years, a third to open control) and UK-TIA Aspirin Trial (N=2449, two-thirds allocated 300 mg or 1200 mg aspirin for 1-7 years, a third placebo control). We also did a systematic review of all relevant observational studies to establish whether associations were consistent with the results of the randomised trials and, if so, what could be concluded about the likely effects of dose and regularity of aspirin use, other non-steroidal anti-inflammatory drugs (NSAID), and the effect of patient characteristics. Results In the randomised trials, allocation to aspirin reduced the incidence of colorectal cancer (pooled HR 0.74, 95% CI 0.56-0.97, p=0.02 overall; 0.63, 0.47-0.85, p=0.002 if allocated aspirin for 5 years or more). However, this effect was only seen after a latency of 10 years (years 0-9: 0.92, 0.56-1.49,…
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Retrospective meta-analyses of selected randomized trials of mainly low-dose aspirin have suggested that aspirin use may result in an incidence of cancer or death from cancer that is 15 to 20% lower than that with control.
“Retrospective meta-analyses of selected randomized trials of mainly low-dose aspirin have suggested that aspirin use may result in an incidence of cancer or death from cancer that is 15 to 20% lower than that with control. 10-13”
From Effects of aspirin for primary prevention in persons with diabetes mellitus (2018) · cites this paper as [13]
In particular, reductions of 30 to 40% in the incidence of gastrointestinal cancers (particularly colorectal cancer) were observed, with the effects appearing to increase with more prolonged exposure and with longer follow-up up to 20 years.
“In particular, reductions of 30 to 40% in the incidence of gastrointestinal cancers (particularly colorectal cancer) were observed, with the effects appearing to increase with more prolonged exposure and with longer follow-up up to 20 years.”
From Effects of aspirin for primary prevention in persons with diabetes mellitus (2018) · cites this paper as [13]
Several meta-analyses of selected randomized trials of generally low-dose aspirin have suggested that aspirin use might reduce the risk of cancer-in particular gastrointestinal tract cancer-by up to one third during long-term follow-up, with effects becoming apparent approximately 3 years after randomization.
“Several meta-analyses of selected randomized trials of generally low-dose aspirin have suggested that aspirin use might reduce the risk of cancer - in particular, gastrointestinal tract cancer - by up to one third during long-term follow-up, with effects becoming apparent approximately 3 years after randomization.”
From Effects of aspirin for primary prevention in persons with diabetes mellitus (2018) · cites this paper as [13]
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- Authors
- Flossmann, E., & Rothwell, P. M.
- Affiliations
- University of Oxford (GB)
- ORCID
- Rothwell, Peter M
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2007-05
- Volume
- 369
- Issue
- 9573
- Pages
- 1603-1613
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2137520566
- Cited by
- 820
- References
- 3
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 16 · 2023: 27 · 2022: 40 · 2021: 40 · 2020: 34 · 2019: 42 · 2018: 38 · 2017: 54 · 2016: 61 · 2015: 38 · 2014: 62 · 2013: 69 · 2012: 63
- FWCI
- 5.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Inflammatory mediators and NSAID effects
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Keywords
- aspirin, colorectal cancer, cancer incidence, long-term risk, colorectal adenoma, nonsteroidal anti-inflammatory drugs, primary prevention, patient characteristics, cancer risk reduction
- MeSH terms
- Adenoma, Animals, Anti-Inflammatory Agents, Non-Steroidal, Aspirin, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Registries, Colorectal Neoplasms, Case-Control Studies, Randomized Controlled Trials as Topic, Cyclooxygenase Inhibitors
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