Nonsteroidal anti-inflammatory drugs (NSAIDS) are medicines that are used for the treatment of a wide range of musculoskeletal illnesses including spinal disorders, osteoarthritis and inflammatory conditions like rheumatoid arthritis. NSAIDs effectively relieve pain, inflammation, and fever. A number of treatment guidelines for osteoarthritis, rheumatoid arthritis, and chronic low back pain recommend the use of NSAIDs for extended periods of time. However, like all medicines, NSAIDs are associated with potential side effects including hypertension and gastrointestinal bleeding. While continued use of NSAIDs for extended periods of time would be thought of as only being associated with prolonged toxicity, doctors from Denmark have published a report on a potential benefit of the prolonged use of low-dose aspirin and NSAIDs.
The Danish physicians reported on a population study evaluating the use of low-dose aspirin or other NSAIDs and colorectal cancer. Colorectal cancer is the third most common non-skin cancer in the world and accounts for about 1.4 million new cancers every year. In the studied population from Northern Denmark, 10,280 cases of cancer were compared to 102,800 controls in regard to aspirin or NSAID drug use. Ever use of aspirin or NSAID was defined as filling 2 prescriptions or less during the study period. The adjusted risk for colorectal cancer for individuals ever having used aspirin was not decreased while a minimal decrease of 6% was associated with ever use of NSAIDs. Continuous use of aspirin was measured in years, while continuous use of NSAIDs was defined by consecutive fillings of at least 2 prescriptions per year. Continuous long-term use of aspirin (greater than 5 years) was associated with a 27% reduction in colorectal cancer risk. Continuous long-term non-aspirin NSAIDs use was associated with a 43% decreased risk. The decrease in risk was noted in particular with NSAIDs with high cyclooxygenase-2 inhibition like celecoxib.
A NSAID will be selected if the agent is the appropriate choice to decrease symptoms of pain and inflammation. Many individuals will decide on whether to take the drug solely based about potential toxicities. They do not consider the potential benefits from short-term and continuous use. A choice of taking or not taking a drug should be decided based on all the pertinent benefits and risks. The study by Friis suggests that a decreased risk of colon cancer should be added to the benefits list.
Reference: Friis S et al. Low-dose aspirin or nonsteroidal anti-inflammatory drug use and colorectal cancer risk. Ann Intern Med 2015;163:347-355
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