LONG-TERM USE OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS AND OTHER CHEMOPREVENTORS AND RISK OF SUBSEQUENT COLORECTAL NEOPLASIA

Our objective was to study the relationship between dispensed aspirin, nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs), steroidal an tiinflammatory drugs (SAIDs), acetaminophen, calcium, psyllium, and mu ltivitamin preparations and the risk for subsequent colorectal adenoma and adenocarcinoma. The design was a case-control study. The patient population was from a large municipal teaching hospital in Atlanta, Ge orgia. In logistic regression models, the risk of colorectal adenoma o r adenocarcinoma decreased in the first two years of continuous NSAID use in a linear, time-dependent manner. The risk of colorectal neoplas ia after two years of continuous NSAID use was reduced significantly ( P < 0.01) as compared to nonusers. Risk reduction appeared greater for adenocarcinoma than adenoma. The use of SAIDs, calcium, multivitamins , and psyllium, as prescribed to our patient population during the mea n six-year study period, conferred no measurable risk reduction. These results suggest that in prospective chemoprevention trials, a signifi cant risk reduction can be expected after only two years of aspirin us e, in doses similar to those recommended for the prevention of cardiov ascular disease, or nonaspirin. NSAIDs, in doses commonly prescribed f or the management of musculoskeletal pain. The results also imply that any short-term reduction in the incidence of colorectal adenoma detec ted in a phase II trial would underestimate the chemopreventive effect of NSAIDs on the risk of adenocarcinoma.