ASPIRIN AND THE RISK OF COLORECTAL-CANCER IN WOMEN
ASPIRIN AND THE RISK OF COLORECTAL-CANCER IN WOMEN
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DOI：
10.1056/nejm199509073331001
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发表时间：
1995-09-07
影响因子：
158.5
通讯作者：
SPEIZER, FE
中科院分区：
文献类型：
--
作者：
GIOVANNUCCI, E;EGAN, KM;SPEIZER, FE
背景：大多数数据表明，规律使用阿司匹林可降低结直肠癌风险，但也存在一些明显相互矛盾的证据。阿司匹林的服用剂量和持续时间对结直肠癌风险的影响尚未完全明确。
方法：我们根据护士健康研究中女性连续规律使用阿司匹林的年数（定义为每周两片或更多）来确定结直肠癌的发病率。这些女性在连续三份问卷（1980年、1982年和1984年）中报告规律使用阿司匹林，并将这组女性的发病率与声称不使用阿司匹林的女性的发病率进行比较。纳入1984年至1992年（1984年问卷之后的8年）期间发生的癌症病例。
结果：从1984年到1992年，在551651人年的随访中，我们记录了331例新的结直肠癌病例。与不使用者相比，持续每周服用两片或更多阿司匹林的女性在4年后（相对风险，1.06；95%置信区间，0.78 - 1.45）或5 - 9年后（相对风险，0.84；95%置信区间，0.55 - 1.28）结直肠癌风险没有明显降低。服用阿司匹林10 - 19年的女性风险略有降低，但无统计学意义（相对风险，0.70；95%置信区间，0.41 - 1.20）。然而，持续使用阿司匹林20年后，风险有统计学意义的降低（相对风险，0.56；95%置信区间，0.36 - 0.90；趋势P = 0.008）。在每周服用4 - 6片的女性中观察到风险最大程度的降低；更高剂量似乎有类似的益处。对包括饮食在内的结直肠癌风险因素进行控制后，结果未改变，而且阿司匹林使用者中结直肠腺瘤的早期诊断和切除并不能解释这些结果。
结论：规律使用阿司匹林，剂量与预防心血管疾病所推荐的剂量相似，可大幅降低结直肠癌风险。然而，这种益处可能在规律服用阿司匹林至少10年后才会明显体现。
Background. Most data suggest that the regular use of aspirin reduces the risk of colorectal cancer, but some apparently conflicting evidence exists. The effects of the dose and the duration of aspirin consumption on the risk of colorectal cancer are not well understood.Methods. We determined rates of colorectal cancer according to the number of consecutive years of regular aspirin use (defined as two or more tablets per week) among women in the Nurses' Health Study who reported regular aspirin use on three consecutive questionnaires (1980, 1982, and 1984) and compared the rates in this group with the rates among women who said they did not use aspirin. Cases of cancer occurring from 1984 through 1992 (the eight years after the 1984 questionnaire) were included.Results. From 1984 through 1992, we documented 331 new cases of colorectal cancer during 551,651 person-years of follow-up. Women who consistently took two or more aspirin tablets per week had no appreciable reduction in the risk of colorectal cancer as compared with nonusers after four years (relative risk, 1.06; 95 percent confidence interval, 0.78 to 1.45) or after five to nine years (relative risk, 0.84; 95 percent confidence interval, 0.55 to 1.28). There was a slight reduction in risk among women who took aspirin for 10 to 19 years, but it was not statistically significant (relative risk, 0.70; 95 percent confidence interval, 0.41 to 1.20). However, there was a statistically significant reduction after 20 years of consistent use of aspirin (relative risk, 0.56; 95 percent confidence interval, 0.36 to 0.90; P for trend=0.008). The maximal reduction in risk was observed among women who took four to six tablets per week; higher doses had a similar apparent benefit. Controlling for risk factors for colorectal cancer, including diet, did not change the results, and the earlier diagnosis and removal of colorectal adenomas among aspirin users did not account for the results.Conclusions. Regular aspirin use, at doses similar to those recommended for the prevention of cardiovascular disease, substantially reduces the risk of colorectal cancer. However, this benefit may not be evident until after at least a decade of regular aspirin consumption.