November 4th, 2011
Podcast 136: Aspirin lowers colorectal risks in Lynch syndrome — what are the implications for everyone else?
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Last week’s Lancet article on the effect of aspirin on risks for colorectal cancer in patients with Lynch syndrome — a group at particularly high risk — may hold implications for preventing sporadic colon cancers.
Our interview with Prof. Sir John Burn, the study’s first author, explores those implications as well speculations on why we human beings aren’t getting the salicylates we were when our vegetables weren’t so pampered.
Links:
- Physician’s First Watch coverge (free)
- Lancet abstract (free)
- NEJM 2008 paper (free)
- The CAPP3 website
2 Responses to “Podcast 136: Aspirin lowers colorectal risks in Lynch syndrome — what are the implications for everyone else?”
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In cardiovascular risk prevention, any ASA doses above 75 mg have no more efficacy and do have a worse side effects profile than 75 mg dosing; in the subset of Diabetes Mellitus patients, some say ASA reduces all cause mortality but the effects on CV specific mortality are nil or beneficial depending on the source. Hemorrhagic stroke and GI bleeding are serious diseases, but the age of people using ASA as CRC prevention may be different to the age when most GI and CNS ASA side effects appear. I know no data about how many of the placebo group GI side effects were connected with the use out of trial, of ASA or other known gastrolesive agents. It’s known also, that all NSAIDs do worsen the CV Risk, in different amount for some of them, but they do. The dose finding and larger sample study on the subject of ASA and Cancer prevention is of high interest, and regarding the subject of hereditary CRC, a trend seems to exist as to study all CRC cases from a genetic point of view, as the study yields a high proportion of abnormal genetic findings. My uncle Fernando – no connection with the songs by Abba and Lady Gaga – used to take 500 mg ASA a day, “to prolong his good health”, he nearly died in his 50’s because of an hemorrhagic gastritis ( No alcohol use at all ). Nobody’s perfect, but even when the decrease in CRC incidence by ASA is a very beautiful finding, it may be better being cautious about ASA and CRC prevention.
Is it the antinflammatory or the anticoagulant effect of aspirin that helps more the prevention of colon cancer? We know that at a low dose (such as 81 mg) aspirin favors the production of prostaglandins over thromboxane (which gives it its anticoagulant effect). The study about Lynch syndrome had a placebo and a 600mg of aspirin arm, but did it have a baby aspirin arm?
Answer: No, it was 600 mg only. [Joe]