Association of non-steroidal anti-inflammatory medications and aspirin with colorectal cancer incidence in older adults

Zaman, FY; van Londen, GJ; Orchard, SG; Polekhina, G; Gibbs, P; Bernstein, WB; Macrae, F; Tie, J; Millar, J; Gately, L; Rodr&#237;guez, LM; Mar, V; Hiscutt, E; Adler, N; Kent, A; Ong, WL; Haydon, A; Warner, E; Chan, AT; Zalcberg, J

Author(s): Zaman, FY; van Londen, GJ; Orchard, SG; Polekhina, G; Gibbs, P; Bernstein, WB; Macrae, F; Tie, J; Millar, J; Gately, L; Rodríguez, LM; Mar, V; Hiscutt, E; Adler, N; Kent, A; Ong, WL; Haydon, A; Warner, E; Chan, AT; Zalcberg, J;
Details: Publication Year 2025-09-01,Volume 117,Issue #9,Page 1875-1882
Journal Title: Journal of the National Cancer Institute
Publication Type: Research article
Abstract: BACKGROUND: The relationship between aspirin, and/or other non-steroidal anti-inflammatory drugs (NSAIDs), and colorectal cancer (CRC) risk in older adults is uncertain. This study investigated the association between non-aspirin NSAIDs (NA-NSAIDs) use, alone or combined with aspirin, on CRC incidence in older adults. METHODS: This is a post hoc analysis of ASPirin in Reducing Events in the Elderly (ASPREE) randomized controlled trial data and its observational continuation, ASPREE-XT (median follow-up, 8.4 years [IQR: 7.2-9.6]). NA-NSAID exposure was ascertained by self-report and medical record review at baseline, for all ASPREE participants, and for Australian participants, via linkage to the Pharmaceutical Benefits Scheme (PBS). CRC was an adjudicated secondary endpoint of ASPREE. We investigated the association between NA-NSAID use alone, and in combination with randomized aspirin use, on the incidence of CRC in time-to-event analyses. RESULTS: Of 19 114 ASPREE participants, 2713 (14%) reported NA-NSAID use at baseline. NA-NSAID use was associated with a reduced incidence of CRC (HRNA-NSAID use: Yes vs No = 0.74; 95% CI = 0.56 to 0.98). This association between NA-NSAIDs and CRC was not modified by aspirin (P-value for interaction term of 0.81). When assessing NA-NSAID use over 2 years post-randomization in Australian participants who consented to the use of PBS data (n = 13 725), a similar reduction in CRC risk was observed (HRHigh NA-NSAID use vs None = 0.52, 95% CI = 0.32 to 0.83). CONCLUSIONS: NA-NSAID use in Australian and American adults over the age of 70 years was associated with a reduced CRC incidence, which increased with increasing exposure. Aspirin did not modify the effect of NA-NSAIDs on CRC incidence.
Publisher: Oxford University Press
Keywords: Aged; Aged, 80 and over; Female; Humans; Male; *Anti-Inflammatory Agents, Non-Steroidal/adverse effects/administration &; dosage/therapeutic use; *Aspirin/administration & dosage/adverse effects/therapeutic use; Australia/epidemiology; *Colorectal Neoplasms/epidemiology/prevention & control/chemically induced; Incidence; Risk Factors; Longitudinal Studies
Department(s): Medical Oncology
Publisher's Version: https://doi.org/10.1093/jnci/djaf145
Open Access at Publisher's Site: https://doi.org/10.1093/jnci/djaf145
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-08-19 12:59:43

Last Modified: 2025-10-28 02:36:06