By Dulce Zamora
New York (MedscapeWire) Nov 7 Colon cancer screening is far more effective than aspirin in preventing development of the disease, according to researchers who used a computer simulation to come up with their findings.
To determine whether aspirin was a good alternative or addition to colon cancer screening, Uri Ladabaum, MD, and colleagues gathered data from other studies that suggested aspirin might have reduced colon cancer risk by 30%-60% and compared those data with statistics related to screening. The study findings were published in the November 6 issue of the Annals of Internal Medicine.
The investigators found screening to be superior. "Taking aspirin is not a substitute [for screening]," says Ladabaum, an assistant professor of medicine at the University of California, San Francisco. "For somebody who's already getting screened, adding aspirin on top of that for colon cancer prevention incurs more risk and more cost than is worth it."
At least one expert, Ernest Hawk, MD, of the National Cancer Institute (NCI), praises the study for emphasizing the importance of colon cancer screening and says investigators posed an interesting research question in asking how aspirin compares to screening. But, he says, the findings currently have little relevance to clinical practice.
"It's a reasonable academic exercise, but the question it's attempting to answer is not being asked by anybody at this point because the data that went into the model are too premature," says Hawk. "There have been no randomized studies to prove that aspirin is effective."
Plus, Hawk says, nobody has yet recommended aspirin be used to prevent colon cancer.
Ladabaum admits that the evidence on aspirin is poor: The data were taken from trials that noted statistics on aspirin use while studying other controlled variables. He says that to his knowledge no one has done a randomized study that specifically looked at the pill's effectiveness in warding off colon cancer. However, he says he and his colleagues wanted to know how much of a protective effect aspirin had to have to make it worthwhile for colon cancer prevention.
"We recognize that the proof isn't there yet for aspirin," says Ladabaum. "So, to some extent, our model simulation addresses the question, 'If we get really solid evidence that confirms the preliminary evidence that aspirin may help in colon cancer prevention would it then make sense for people to take it?' "
Ann Intern Med. 2001;135(9):769-781
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