Esophageal carcinomas have high fatality rates, therefore chemoprevention agents are desirable.
In this study, researchers from California, USA, conducted a systematic review, with meta-analysis, of studies evaluating the association of aspirin/nonsteroidal anti-inflammatory drug (NSAID) use and esophageal cancer.
The team evaluated the MEDLINE, BIOSIS, and Web of Science electronic databases, from 1980 to 2001, manually reviewed the literature, and consulted with experts.
They included studies if they:
- Evaluated exposure to NSAIDs, aspirin, or both.
- Evaluated esophageal cancer.
- Reported relative risks or odds ratios or provided data for their calculation.
The data were then independently abstracted by 2 investigators.
The primary and sensitivity analyses used both fixed and random-effects models.
|Any use of aspirin or NSAIDs was protective against both esophageal adenocarcinoma, and squamous cell carcinoma.|
The team identified 9 studies (2 cohort, 7 case control) containing 1813 cancer cases.
All primary summary estimates were homogeneous.
The research team found that statistical pooling showed a protective association between any use of aspirin/NSAID and esophageal cancer (odds ratio = 0.57).
The also determined that both intermittent (OR = 0.82) and frequent medication use were protective (OR = 0.54). Although more frequent use conferred greater protection.
When the results were stratified by medication type, aspirin use was found to be protective (OR = 0.5), while NSAIDs had a borderline protective association (OR = 0.75).
However, any use was protective against both esophageal adenocarcinoma (OR = 0.67), and squamous cell carcinoma (OR = 0.58).
Dr Douglas Corley's team concluded, "Pooled results support a protective association between aspirin, and NSAIDs, and esophageal cancer…and provide evidence for a dose effect".
"These findings support evaluating these agents in clinical trials of high-risk patients".
In a related editorial in the same publication, Dr Micheal Thun discusses the importance of chemoprevention in esophageal cancer.
He concludes, however, that in spite of promising results in cancer prevention, NSAIDs are not able to be recommended for this use until the balance of risks and benefits has been addressed.