Association between use of non-aspirin non-steroidal anti-inflammatory drugs and detection of colorectal polyps and cancer in a screening setting.

Abstract

Background: While substantial evidence supports a protective effect of aspirin against colorectal polyps and cancer, the evidence for non-aspirin non-steroidal anti-inflammatory drugs (NA-NSAIDs) remains limited. We studied the association between the use of NA-NSAIDs and the detection of colorectal polyps and cancer among screening participants.

Methods: We selected participants in the Bowel Cancer Screening trial in Norway-a randomized trial comparing once-only sigmoidoscopy and the biennial faecal immunochemical test (FIT). Using multivariable logistic regression, we estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between NA-NSAID use in the 4 years before the screening invitation and detection of colorectal cancer (CRC), adenomas, advanced adenomas, and advanced serrated polyps. Long-term use was defined as ≥2 years of use.

Results: Of 64,889 participants (24,159 sigmoidoscopy, 40,730 FIT), 35,867 (55.3%) were NA-NSAID users, 314 (0.5%) had CRC, 6,208 (9.6%) had adenomas, and 659 (1.0%) had advanced serrated polyps. NA-NSAID users had lower odds of CRC (OR 0.80; 95% CI 0.64-1.00), adenomas (OR 0.94; 95% CI 0.89-1.00), and advanced adenomas (OR 0.87; 95% CI 0.80-0.95) than those with no NA-NSAID prescription. For non-selective NA-NSAIDs, the results were similar to those for any NA-NSAIDs (CRC: OR 0.79, 95% CI 0.63-0.99; adenomas: OR 0.93, 95% CI 0.88-0.99; advanced adenomas: OR 0.87, 95% CI 0.79-0.95). COX2-selective NA-NSAIDs were not associated with CRC or adenomas. Among the long-term NA-NSAIDs users, the ORs were 0.59 (95% CI 0.27-1.26) for CRC, 0.65 (95% CI 0.54-0.79) for adenomas, and 0.59 (95% CI 0.44-0.80) for advanced adenomas. No association was observed between any NA-NSAID use and advanced serrated polyps. The results were consistent across trial arms and sexes.

Conclusion: Our findings suggest that use of NA-NSAIDs, in particular non-selective NA-NSAIDs, might be associated with a reduced risk of adenomas and CRC, but not advanced serrated polyps.