Aspirin May Help Prevent Throat Cancer

Study finds NSAID painkillers may fight malignancy linked to Barrett's esophagus

TUESDAY, Nov. 8, 2005 (HealthDay News) -- Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) may help prevent esophageal cancer from developing in patients with Barrett's esophagus, researchers report.

Barrett's esophagus is a precancerous condition in which the esophagus changes so that some of its lining is replaced by tissue similar to that normally found in the intestine. People with Barrett's esophagus are 50 times more likely to develop a type of throat cancer called esophageal adenocarcinoma, the most rapidly increasing cancer in the United States.

"We observed that people who had Barrett's esophagus who were taking aspirin and other NSAIDs were about a third less likely to go on to get esophageal cancer, compared with people who never took NSAIDs regularly," said study author Dr. Thomas L. Vaughan, head of the epidemiology program at Fred Hutchinson Cancer Research Center in Seattle.

Besides aspirin, the NSAID group of pain relievers include ibuprofen, naproxen and the Cox-2 painkillers Vioxx, Bextra and Celebrex -- of which only Celebrex remains on U.S. drugstore shelves.

Reporting in the Nov. 7 online edition of The Lancet Oncology, Vaughan and his colleagues collected data on 350 people diagnosed with Barrett's esophagus. For more than five years, Vaughan's team looked at whether NSAID use correlated with the development of esophageal adenocarcinoma in these patients.

They found that people taking NSAIDs were at a 68 percent lower risk of developing esophageal adenocarcinoma, compared with people who didn't use the drugs.

Among people who had taken NSAIDs in the past (but not now) the risk of cancer was lower, but not significantly lower, than that of people who had never used the drugs on a regular basis, Vaughan's group found. The five-year incidence of esophageal adenocarcinoma was 14.3 percent among participants who had never used NSAIDs, 9.7 percent among people who had used them regularly at some time in the past, and 6.6 percent among those currently using NSAIDs.

"I think this is a pretty exciting finding that gives hope to people with Barrett's," Vaughan said. "It gives hope that there may be some prevention, because right now there is no medical or surgical treatment that has been shown to reduce risk in those people."

One expert believes the results of this study are encouraging, but need to be proven in clinical trials.

"This is an exciting, well-conducted study," said Eric Jacobs, a senior epidemiologist at the American Cancer Society. "If in the future drugs such as aspirin are proven to substantially reduce progression to cancer for people with Barrett's, it could save lives."

Jacobs was careful to note that this trial was only a small observational study. "We need evidence from randomized clinical trials before we recommend using NSAIDs for cancer prevention in people with Barrett's," he cautioned.

According to Jacobs, there are two things everybody can do now to help prevent esophageal cancer. "The first is not to smoke, and if you do smoke, quit," he said. "The second is to maintain a good body weight and exercise."

Another expert said the finding could prove valuable in preventing esophageal cancer.

"Esophageal adenocarcinoma in people with Barrett's esophagus is one of the fastest-growing cancers, and if this finding holds up in a larger population it might be very important," said Dr. Peter Barrett, an assistant professor and medical director of the cardiothoracic surgery intensive care unit at Yale University Medical School.

"If inexpensive medications such as NSAIDs can help prevent esophageal adenocarcinoma, it is certainly very positive news," Barrett said. "We do know that NSAID use in colorectal cancer helps prevent precancerous polyps. If this would hold up in the esophagus, it would be important."

Barrett said he currently recommends that people over 40 take aspirin to help prevent heart attack and stroke. Preventing esophageal adenocarcinoma may be an added benefit, he said.

Another expert noted that taking aspirin can have a downside.

"Even as the evidence mounts that aspirin and other NSAIDs may lower your likelihood of certain cancers, the well-documented risks of stomach bleeding requires a discussion with your doctor to determine whether the benefits of using these agents is worth the known risks," said Dr. A. Mark Fendrick, a professor of internal medicine and health management and policy at the University of Michigan.

More information

For more on Barrett's esophagus, head to the National Digestive Diseases Information Clearinghouse.

SOURCES: Thomas L. Vaughan, M.D., head, epidemiology program, Fred Hutchinson Cancer Research Center, Seattle; Eric Jacobs, Ph.D., senior epidemiologist, American Cancer Society, Atlanta; Peter Barrett, M.D., assistant professor and medical director, cardiothoracic surgery intensive care unit, Yale University Medical School, New Haven, Conn.; A. Mark Fendrick, M.D., professor, internal medicine and health management and policy, University of Michigan, Ann Arbor; Nov. 8, 2005, The Lancet Oncology online
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