Abstract
Evidence from a wide range of sources suggests that individuals taking aspirin and related non-steroidal anti-inflammatory drugs have reduced risk of large bowel cancer. Work in animals supports cancer reduction with aspirin, but no long-term randomised clinical trials exist in human beings, and randomisation would be ethically unacceptable because vascular protection would have to be denied to a proportion of the participants. However, opportunistic trials of aspirin, designed to test vascular protection, provide some evidence of a reduction in cancer, but only after at least 10 years. We summarise evidence for the potential benefit of aspirin and natural salicylates in cancer prevention. Possible mechanisms of action and directions for further work are discussed, and implications for clinical practice are considered.
MeSH terms
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Animals
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Anti-Inflammatory Agents, Non-Steroidal / pharmacology
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Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
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Apoptosis / drug effects
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Aspirin / pharmacology
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Aspirin / therapeutic use*
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Breast Neoplasms / prevention & control
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Case-Control Studies
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Cohort Studies
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Colonic Neoplasms / prevention & control
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Cyclooxygenase Inhibitors / pharmacology
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Cyclooxygenase Inhibitors / therapeutic use
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DNA Mismatch Repair / drug effects
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Drug Evaluation, Preclinical
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Evidence-Based Medicine* / organization & administration
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Female
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Humans
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Intestinal Polyps / prevention & control
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Male
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Neoplasms / epidemiology
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Neoplasms / etiology
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Neoplasms / prevention & control*
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Prostaglandin-Endoperoxide Synthases / drug effects
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Prostatic Neoplasms / prevention & control
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Randomized Controlled Trials as Topic
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Risk Reduction Behavior
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Time Factors
Substances
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Anti-Inflammatory Agents, Non-Steroidal
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Cyclooxygenase Inhibitors
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Prostaglandin-Endoperoxide Synthases
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Aspirin