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Influence of aspirin on prevention of colorectal cancer: an updated systematic review and meta-analysis of randomized controlled trials

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Colorectal cancer is the second most common cause of cancer death worldwide. Aspirin, due to its antineoplastic effects, has been suggested to have chemopreventive effects on colorectal cancer based on recent trials. We conducted this systematic review and meta-analysis to provide an updated evidence about the long-term efficacy of daily aspirin use in the prevention of colorectal cancer.

Methods

We searched Medline/PubMed, Ovid, Web of Science, and Cochrane Library. We included randomized controlled trials (RCTs) that compared the efficacy of daily aspirin use to placebo in healthy individuals at the time of study entry. The desired outcomes of this review were the incidence of advanced lesions (i.e., adenomas with villous component, adenomas ≥1 cm in diameter, adenomas with high-grade dysplasia, and/or invasive cancer) and colorectal adenomas.

Results

A total of 15 articles representing 11 RCTs were included. Overall, the results indicated that aspirin significantly reduced the risk of developing colorectal adenomas but not advanced lesions at 3 years (risk ratio (RR) = 0.84, P < 0.05 and risk ratio = 0.82, P = 0.10, respectively). At 5 years, the risk of advanced lesions but not adenomas was reduced by aspirin (RR = 0.68, P < 0.05 and RR = 0.87, P = 0.22, respectively). Aspirin was not found to have an effect on the risk of advanced lesions or adenomas beyond 5 years (hazard ratio (HR) = 0.82, P = 0.07 and HR = 0.99, P = 0.82, respectively).

Conclusion

Overall, aspirin (particularly high dose) only reduced the risk of advanced lesions up to 5 years.

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Data availability

All data are available on request.

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Acknowledgements

The authors thank Abdullah F Bokhari, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia, for his contributions in this study.

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Authors and Affiliations

  1. College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, 22384, Saudi Arabia

    Abdullah A. Ghaddaf, Mohammed S. Alomari, Ahmed S. Abdulhamid, Fahad A. Alharbi, Abdullah N. Mullah & Syed Fasial Zaidi

  2. King Abdullah International Medical Research Center, Jeddah, 22384, Saudi Arabia

    Abdullah A. Ghaddaf, Mohammed S. Alomari, Ahmed S. Abdulhamid, Fahad A. Alharbi, Abdullah N. Mullah & Syed Fasial Zaidi

  3. Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA

    Muhammad Aziz

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Contributions

Abdullah A Ghaddaf contributed to the research idea, design of the study, data extraction, statistical analysis and interpretation, risk of bias assessment, writing, editing, and approval of the final manuscript; Muhammad Aziz, MD, contributed to the statistical analysis and interpretation, risk of bias assessment, editing, and approval of the final manuscript; Mohammed S Alomari contributed the design of the study, data extraction, statistical analysis and interpretation, writing, editing, and approval of the final manuscript; Ahmed S Abdulhamid, Fahad A Alharbi, and Abdullah N Mullah contributed to the data extraction, statistical analysis and interpretation, risk of bias assessment, writing, editing, and approval of the final manuscript; Sayed F Zaidi, PhD, contributed to the statistical analysis and interpretation, and approval of the final manuscript.

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Correspondence to Abdullah A. Ghaddaf.

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Ghaddaf, A.A., Aziz, M., Alomari, M.S. et al. Influence of aspirin on prevention of colorectal cancer: an updated systematic review and meta-analysis of randomized controlled trials. Int J Colorectal Dis 36, 1711–1722 (2021). https://doi.org/10.1007/s00384-021-03880-3

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