By, Robert A. Wascher, MD, FACS
Last Updated: 03/1/2009
The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.
ASPIRIN & COLORECTAL CANCER PREVENTION
Non-steroidal anti-inflammatory drugs, or NSAIDs, have previously been shown to reduce the incidence of polyps and cancers of the colon and rectum. This class of drugs includes the well-known medications ibuprofen, naproxen, sulindac, indomethacin, Celebrex, Vioxx, and aspirin, among others. However, enthusiasm for using NSAIDs as colorectal polyp and cancer prevention drugs has cooled significantly after several large prospective clinical research studies linked several of these drugs, including Celebrex and the subsequently discontinued Vioxx, to an increased risk of heart disease. Fortunately, aspirin, which is a weak NSAID, is still thought to protect the heart against coronary artery disease. However, previous clinical research studies have suggested that daily aspirin use only provides very modest protection, if any, against polyps and cancers of the colon and rectum. Now, a new study, just published in the Journal of the National Cancer Institute, comprehensively reviews the results of 4 prospective clinical colorectal cancer prevention research studies, and suggests that the humble aspirin pill may, indeed, offer significant protection against the type of colorectal polyps (adenomas) that are believed to give rise to virtually all colorectal cancers.
This new study performed a complex statistical evaluation, called a meta-analysis, of 4 prospective, randomized, placebo-controlled colorectal cancer prevention trials that, together, included almost 3,000 patient volunteers. The average age of these patient volunteers was 58 years, and average patient follow-up of these nearly 3,000 patients was about 3 years. Colonoscopy was performed on about 2,700 of these patients during the course of these 4 studies. Among the patients who were secretly randomized to receive placebo (sugar) pills, 37 percent were found to develop polyps (adenomas) of the colon or rectum during the course of these clinical studies. Among the patients who were secretly assigned an aspirin pill each day, 33 percent were found to harbor colorectal adenomas while being observed. Advanced precancerous adenomas were also identified in 12 percent of the patients in the placebo group, while 9 percent of the patients in the daily aspirin group were found to have advanced premalignant adenomas.
After analyzing the data, the authors of this study determined that any dose of aspirin between 81 mg and 325 mg per day was associated with a 17 percent reduction in the relative risk of colorectal adenomas, and an absolute reduction in the risk of adenomas of about 7 percent. Moreover, a daily aspirin pill was associated with a 28 percent relative reduction in the risk of developing advanced high-risk adenomas (i.e., the type of colon or rectal polyp that is most likely to subsequently progress to become a cancer).
In summary, based upon data from 4 different prospective, randomized, placebo-controlled clinical colorectal cancer prevention research studies, a daily baby aspirin, or a daily 325 mg “regular aspirin pill, significantly reduced the incidence of colon and rectal polyps, and especially the high-risk forms of adenomatous polyps that are more likely to progress to colon and rectal cancers.
If you are not already taking aspirin, you should first consult with your physician before beginning aspirin therapy. Aspirin, like all NSAIDs, can cause ulcerations in the GI tract, as well as kidney damage, in susceptible patients. If there are no contraindications to taking aspirin in your case, however, then you may be able to reduce not only your risk of cardiovascular disease, but also your risk of colorectal cancer as well, by taking a daily aspirin tablet.
FISH OIL & RESPIRATORY INFECTIONS IN CHILDREN
The available research evidence suggests that a diet rich in coldwater fish may significantly reduce the risk of heart disease. There is also additional research suggesting that oil from coldwater fish might also improve immune system function, particularly in young children. A newly published study in the Journal of Pediatrics now suggests that fish oil supplements may actually reduce the risk of common acute illnesses in school children.
In this study, nearly 200 schoolchildren between the ages of 9 and 12 years were randomized to receive either a placebo (sugar) pill or a fish oil supplement pill 5 days per week. The children were all monitored for 6 months, and logs were kept of all illnesses that occurred in these kids.
At the end of the study, the researchers determined that the kids who were randomized to receive the fish oil supplements had a significantly lower incidence of acute childhood illnesses, and respiratory infections in particular, when compared to the children who had been randomized to receive placebo pills instead. Respiratory infections, when they occurred, also appeared to resolve more quickly in the group of children who had received fish oil supplements, when compared to the kids in the placebo group. The researchers also measured the levels of several different immune-system-related substances in the blood of these patient volunteers, including TGF-beta protein, a substance which is known to impair the function of immune system cells. Among the children in the fish oil supplement group, TGF-beta levels in the blood were actually significantly lower than was observed among the children in the placebo group. The researchers, therefore, concluded that fish oil supplements appeared to decrease both the frequency and duration of acute illnesses in schoolchildren, and respiratory illnesses in particular. Immune-suppressing TGF-beta blood levels were also lower among the children who were randomized to receive fish oil supplements.
Before considering fish oil supplements for your child, please make sure to consult with your pediatrician first. Large doses of fish oil can expose children to potentially toxic doses of heavy metals and pesticides, and can also excessively thin the blood.
Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity
Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California
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