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Effect of aspirin and NSAIDs on risk and survival from colorectal cancer
  1. Farhat V N Din1,
  2. Evropi Theodoratou2,
  3. Susan M Farrington1,
  4. Albert Tenesa1,
  5. Rebecca A Barnetson1,
  6. Roseanne Cetnarskyj3,
  7. Lesley Stark1,
  8. Mary E Porteous4,
  9. Harry Campbell2,
  10. Malcolm G Dunlop1
  1. 1Colon Cancer Genetics Group and Academic Coloproctology, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital, Edinburgh, UK
  2. 2Public Health Sciences, University of Edinburgh, Edinburgh, UK
  3. 3Faculty of Life Sciences, Edinburgh Napier University, Craiglockhart Campus, Edinburgh, UK
  4. 4Southeast of Scotland Clinical Genetic Services, Western General Hospital, Edinburgh, UK
  1. Correspondence to Professor Malcolm G Dunlop, Colon Cancer Genetics Group and Academic Coloproctology, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital, Edinburgh EH4 2XU, UK;{at}


Background Previous studies have shown that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) lower colorectal cancer (CRC) risk. However, the lowest effective NSAID dose, treatment duration, and effects on survival are not defined. In a large population-based case–control study, we have explored the relationship between NSAID dose and duration, CRC risk and overall CRC-specific survival.

Methods The relationship between NSAID use and CRC risk was examined in 2279 cases and 2907 controls. Subjects completed food-frequency and lifestyle questionnaires. NSAID categories were low-dose aspirin (75 mg), non-aspirin NSAIDs (NA-NSAIDs) and any NSAID. Users were defined as taking >4 tablets/week for >1 month. ORs were calculated by logistic regression models and adjusted for potential confounding factors. Effect of NSAID use on all-cause and CRC-specific mortality was estimated using Logrank tests and Cox's hazard models.

Results In all, 354 cases (15.5%) were taking low-dose aspirin compared to 526 controls (18.1%). Low-dose aspirin use was associated with decreased CRC risk (OR 0.78 95% CI 0.65 to 0.92, p=0.004), evident after 1 year and increasing with duration of use (ptrend=0.004). NA-NSAID and any NSAID use were also inversely associated with CRC. There was no demonstrable effect of NSAIDS on all-cause (HR 1.11, p=0.22, 0.94–1.33) or CRC-specific survival (HR 1.01, p=0.93, 0.83–1.23).

Conclusion This is the first study to demonstrate a protective effect against CRC associated with the lowest dose of aspirin (75 mg per day) after only 5 years use in the general population. NSAID use prior to CRC diagnosis does not influence survival from the disease.

  • Colorectal cancer
  • aspirin
  • NSAIDs
  • chemoprevention
  • cancer prevention
  • non-steroidal anti-inflammatory drugs

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  • FVND & ET are joint first authors and contributed equally to this study.

  • Funding The work was funded by grants from Cancer Research UK C348/A3758, C348/A8896), Scottish government Chief Scientist Office (K/OPR/2/2/D333, CZB/4/94); Medical Research Council (G0000657-53203); Centre Grant from CORE as part of the Digestive Cancer Campaign ( ET is funded by Cancer Research UK Fellowship C31250/A10107. FVND is funded by Cancer Research UK Clinician Scientist Fellowship C26031/A11378.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Multicentre Research Ethics Committee, UK.

  • Provenance and peer review Not commissioned; externally peer reviewed.