It has long been known that people who took aspirin regularlywere less likely to
ID: 2952881 • Letter: I
Question
It has long been known that people who took aspirin regularlywere less likely to develop tumors of the colon, and now a studyhas found that even after a diagnosis of colorectal cancer,patients who took aspirin had a much better chance of survivingthan nonusers.
The improvements in outcomes were striking. Patients withcolorectal cancer who regularly used aspirin before and after adiagnosis were almost one-third less likely to die of the diseasethan nonusers. Patients who initiated aspirin use only after adiagnosis did even better and had half the risk of dying from thecancer, possibly because of differences in their tumors. Thepatients were all being treated for nonmetastatic, or localized,cancers, which are confined to the organ where the cancer began,and were followed for almost 12 years on average.
The study, written by researchers from HarvardMedical School, Massachusetts General Hospital and the Dana-FarberCancer Institute, is being published in this week's Journalof the AmericanMedical Association. An abstract is available online.
"This is a remarkable breakthrough – for a pill that costsa penny," said Dr. Alfred Neugut, a coloncancer expert at Columbia University's College of Physiciansand Surgeons, who was not involved in the research. "Aspirin is nota benign drug, so I can't recommend purely on the basis of thisstudy that someone should take aspirin, but it's pretty darnclose."
It's too early for an across-the-board recommendation, saidHarvard's Dr. Andrew Chan, who led the study. The results should beconfirmed in an experiment where patients would be randomlyassigned to take aspirin or a dummy pill.
The new research was based on an observational study thatfollowed 1,279 men and women with nonmetastatic colorectal cancer,and thus was not the kind of randomized controlled clinical trialconsidered the gold standard for determining the course oftreatment.
What lends credence to the results is that doctors understandthe biological mechanism by which aspirin may prevent the growthand slow the spread of colon cancer, since most colorectal cancertumors are positive for cyclooxygenase-2, or COX-2, an enzyme thatis not expressed in a healthy colon but flares up under certaincircumstances. Aspirin is a COX-2 inhibitor.
Explanation / Answer
a)What are the number and type of subjects involved?.
The subjects were those individuals being treated forlocalized colorectal cancer
b)Any counclusions that were drawn? Aspirin prevents deathfrom COLON CANCER. SPECIFICALLY...
Those subjects treated for localized colorectalcancer who regularly used aspirin before and after adiagnosis were almost one-third less likely to die of thecancer when compared with nonusers. Patients who initiatedaspirin use only after a diagnosis had half the risk of dying fromthe cancers. Particularly responsive to aspirin use were those thatexpress COX-2, they had a 61 percent drop in death rate comparedwith patients who used aspirin but had tumors that did not expressCOX-2 or had only weak expression.
c)How long the study was conducted
The patients were followed for almost 12 years on average.
d)How the subjects were selected?
They were an observational group of 1,279 men and womendiagnosed at the hospitals in Massachusetts (see names likeHarvard) with nonmetastatic colorectal cancer, includinga subgroup of 459 patients whose tumors overexpressed theCOX-2 enzyme
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