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Previous Volume 356:2131-2142 May 24, 2007 Number 21 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Drazen, J. M. Editorial by Markowitz, S. D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Regular use of aspirin reduces the risk of a colorectal neoplasm, but the mechanism by which aspirin affects carcinogenesis in the colon is not well understood.

Methods We estimated cyclooxygenase-2 (COX-2) expression by immunohistochemical assay of sections from paraffin-embedded colorectal-cancer specimens from two large cohorts of participants who provided data on aspirin use from a questionnaire every 2 years. We applied Cox regression to a competing-risks analysis to compare the effects of aspirin use on the relative risk of colorectal cancer in relation to the expression of COX-2 in the tumor.

Results During 2,446,431 person-years of follow-up of 82,911 women and 47,363 men, we found 636 incident colorectal cancers that were accessible for determination of COX-2 expression. Of the tumors, 423 (67%) had moderate or strong COX-2 expression. The effect of aspirin use differed significantly in relation to COX-2 expression (P for heterogeneity=0.02). Regular aspirin use conferred a significant reduction in the risk of colorectal cancers that overexpressed COX-2 (multivariate relative risk, 0.64; 95% confidence interval [CI], 0.52 to 0.78), whereas regular aspirin use had no influence on tumors with weak or absent expression of COX-2 (multivariate relative risk, 0.96; 95% CI, 0.73 to 1.26). The age-standardized incidence rate for cancers that overexpressed COX-2 was 37 per 100,000 person-years among regular aspirin users, as compared with 56 per 100,000 person-years among those who did not use aspirin regularly; in contrast, the rate for cancers with weak or absent COX-2 expression was 27 per 100,000 person-years among regular aspirin users, as compared with 28 per 100,000 person-years among nonregular aspirin users.

Conclusions Regular use of aspirin appears to reduce the risk of colorectal cancers that overexpress COX-2 but not the risk of colorectal cancers with weak or absent expression of COX-2.

Source Information

From the Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School (A.T.C.); the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School (S.O.); the Department of Medical Oncology, Dana–Farber Cancer Institute (S.O., C.S.F.); and the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (A.T.C., C.S.F.) — all in Boston.

Address reprint requests to Dr. Chan at the Gastrointestinal Unit, Massachusetts General Hospital, 55 Fruit St., GRJ 728A, Boston, MA 02114, or at achan{at}partners.org.

Full Text of this Article

Related Letters:

Aspirin, COX-2, and the Risk of Colorectal Cancer
Benelli R., Murashige N., Kami M., Ikeda M., Chan A. T., Ogino S., Fuchs C. S.
Extract | Full Text | PDF  
N Engl J Med 2007; 357:824-825, Aug 23, 2007. Correspondence

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