Prevention
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Nonsteroidal anti-inflammatory drugs (NSAIDs) are very common agents available over-the-counter and by prescription that are used to relieve pain. They have specific actions against prostaglandins and the enzymes called cyclooxygenases (COX 1, COX 2, or both), which have with colon cancer risk.
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Over-the-Counter NSAIDs. Over the counter NSAIDs include aspirin, ibuprofen (Motrin, Advil, Nuprin, Rufen), and naproxen (Aleve). A number of studies have reported that taking these agents at doses similar to those commonly taken to relieve arthritis pain is associated with a lower rate of colorectal cancer by up to 40% over the long term. For example, landmark studies in 2003 reported protection in high-risk patients with even low daily doses of aspirin (81 mg, one "baby" aspirin). Long-term use of any NSAID increases the risk for gastrointestinal bleeding and ulcers, however, and experts to not yet recommend NSAIDs for prevention of colon cancer. They are certainly no substitute for regular screening procedures to catch cancer at an early, and curable, stage.
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Prescription NSAIDs for Prevention of Hereditary Cancers. Some studies report that the potent prescription NSAIDs indomethacin and sulindac can cause regression of polyps and stave off colon cancer for several years in people with FAP. A 2002 study in children and young adults with FAP who were given sulindac for four years, however, did not show any reduction in new polyp formation. More research is needed to determine if NSAIDs have preventive value in high-risk individuals.
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COX-2 Inhibitors. Selective COX-2 inhibitors, such as celecoxib (Celebrex) and rofecoxib (Vioxx), are newer enzymes that only block the enzyme cyclooxygenase-2 (COX-2), which has been specifically linked to colon cancer. Both are being investigated for possible protection against colon cancer. Early studies indicate that celecoxib may help prevent new growth and retard the growth of existing polyps. Experts hope, then, COX-2 inhibitors may prevent colon cancer without posing as high a danger of bleeding and ulcers as standard NSAIDs. Celecoxib has now been approved for patients with familial adenomatous polyposis (FAP). Studies report significant reduction in disease activity in the large and small intestines of these patients.
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