[PHNUTR-L] Aspirin & similar drugs may cut risk of esophageal
cancer in people with Barrett's esophagus
Kathrynne Holden, MS, RD
fivestar at nutritionucanlivewith.com
Tue Nov 8 05:44:37 PST 2005
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Public release date: 7-Nov-2005
Contact: Dean Forbes
dforbes at fhcrc.org
Fred Hutchinson Cancer Research Center
Aspirin & similar drugs may cut risk of esophageal cancer in people with
With sidebar on ways to prevent heartburn, a risk factor for Barrett’s
SEATTLE–- Aspirin and other nonsteroidal anti-inflammatory drugs, such
as ibuprofen, may significantly reduce the risk of esophageal cancer
among people with Barrett's esophagus, a precancerous condition
associated with chronic heartburn that affects an estimated 1 million to
2 million Americans.
These findings, by Thomas L. Vaughan, M.D., M.P.H., and colleagues at
Fred Hutchinson Cancer Research Center, will appear Nov. 8 in the online
edition of The Lancet Oncology. Researchers at Virginia Mason Medical
Center in Seattle and The Brigham and Women's Hospital and Harvard
Medical School in Boston also collaborated on the study, which was
funded by the National Institutes of Health.
In the largest and longest observational study of its kind, lead author
Vaughan and colleagues studied the impact of nonsteroidal
anti-inflammatory drugs, or NSAIDs, on changes in the lining of the
esophagus that signal the advancement toward cancer.
"We found that people with Barrett's esophagus who regularly took NSAIDs
like aspirin or ibuprofen did not go on to get cancer as frequently or
as soon as people who did not take these medications regularly," said
Vaughan, head of the Epidemiology Program and member of the Hutchinson
Center's Public Health Sciences Division. "Current users of NSAIDs had
one-third the risk of getting esophageal adenocarcinoma as compared to
never users," he said.
Five years after joining the study, the incidence of esophageal cancer
was 14.4 percent among never users, 9.7 percent among former users
(those who had used NSAIDs regularly for a year or more prior to joining
the study) and 6.6 percent among current users (those who took NSAIDs at
least once a week).
Because this was a long-term observational study and not a clinical
trial, the investigators cannot recommend NSAIDs for people with
Barrett's esophagus and they advise anyone who considers taking these
medications for this condition should do so under the direction of a
"If I had Barrett's I'd be looking for anything that would help, and
this is something that might help," said Vaughan, also a professor of
epidemiology at the University of Washington School of Public Health and
Community Medicine. "But since these drugs can have serious side
effects, such as gastrointestinal bleeding, this is a decision that
Barrett's patients should make with their doctor."
Although the researchers' results suggest that regular, current use of
NSAIDs may inhibit the progression of Barrett's esophagus, they also
found that the protective effect wears off pretty quickly. "The
protective association appears to be limited to current users," Vaughan
said. "Once you quit taking aspirin or other NSAIDs the effect rapidly
disappears." After three years of discontinuing use of NSAIDs, a
person's risk of developing esophageal cancer reverts back to that of a
never user, he said.
Previous randomized clinical trials in humans have shown that aspirin
and other NSAIDs significantly reduce the risk and mortality for
cardiovascular disease and colorectal cancer. Preliminary studies also
suggest these drugs may be protective against breast and lung cancers.
It is hypothesized that NSAIDs may fight cancer by reducing chronic
inflammation, which is a driving force behind the development of many
cancers and other diseases. Specifically, NSAIDs have been shown to
inhibit the production of the cyclooxygenase-2 (COX-2) enzyme.
Disruption of this pathway slows the growth of abnormal cells and
facilitates the normal process of programmed cell death, or apoptosis,
both of which can thwart cancer development.
While the risk of developing esophageal cancer in a person with
Barrett's is only about 1 percent per year, the outlook is grim if the
disease is not diagnosed early. The majority of patients with invasive
esophageal cancer die within a year of diagnosis.
"Most Barrett's patients will never get esophageal cancer, but since it
is such a rapidly fatal cancer once you get it, it's very important to
identify ways to prevent it," Vaughan said. "This research gives us hope
that there may be an inexpensive, accessible and relatively safe way to
lower Barrett's-related cancer risk."
Currently there is no proven medical or surgical therapy for lowering
esophageal-cancer risk in people with this condition; care is limited to
treating symptoms of reflux, or heartburn, and frequent endoscopic
surveillance, which involves inserting a tube-like instrument down the
throat to examine the esophageal lining and to take tissue samples that
are examined for signs of cancer or precancerous changes.
For the study, Vaughan and colleagues collected data between 1995 and
2003 from 350 people with Barrett's esophagus. Upon entering the study
the participants were interviewed about their medical history, diet and
medication use, and they gave a blood sample. The participants were then
closely monitored for signs of disease progression through regular
endoscopies. Frequency of endoscopic surveillance was determined by the
stage of the condition.
The study participants were selected from a group of more than 450
Barrett's patients whose disease progression is being carefully
monitored through the Seattle Barrett's Esophagus Program, a
multidisciplinary research effort established in 1983 at the University
of Washington. The goals of the program, now based at the Hutchinson
Center and conducted in collaboration with researchers at UW, are to
understand the biological mechanisms by which esophageal cancer
develops, to identify lifestyle and other factors that promote or
inhibit progression toward cancer, and to identify genetic markers of
increased risk so the disease can be prevented or detected early, while
it is still curable. The Barrett's research team, led by Hutchinson
Center researcher Brian J. Reid, M.D., Ph.D., and co-author of The
Lancet Oncology paper, has shown that a systematic, multidisciplinary
approach to early cancer detection can boost the five-year survival rate
for esophageal cancer from about 10 percent to more than 80 percent.
Other promising research findings from the Seattle team – all of which
require additional research – suggest that reducing overweight and
quitting smoking also may prevent progression of Barrett's.
Esophageal cancer strikes more than 14,500 Americans a year, according
to the American Cancer Society, and since the late 1990s the incidence
of the most common form, esophageal adenocarcinoma (the type associated
with Barrett's) has been rising faster than that of any other cancer in
the United States, increasing fourfold to ninefold in different areas of
the country since 1974. Esophageal adenocarcinoma, which accounts for
about 60 percent of esophageal-cancer cases, is most prevalent among
residents in western Washington for reasons not yet known, Vaughan said.
While the condition is eight times more common in men than women and
five times more common in white males than black males, the rates are
rising as well among women and African Americans.
"The incidence of esophageal adenocarcinoma is rising really fast in
Westernized countries, and we're not really sure of the reason," Vaughan
said. "However, it looks like obesity is a driving factor, partly
because it promotes acid reflux, a key risk factor for both Barrett's
and cancer. But it's pretty likely that there's something else going on,
too, because obesity is just as high in women and African Americans.
Hormonal factors also might be important, but at this point we just
For more information about the Seattle Barrett's Esophagus Program,
visit www.fhcrc.org/science/barretts. For more information about
Barrett's esophagus, visit www.barrettsinfo.com, a peer-reviewed Web
site developed by researchers at the Hutchinson Center and UW that is
supported by AstraZeneca LP through an unrestricted educational-research
grant from the Ryan Hill Research Foundation, Seattle.
Kristen Woodward (Nov. 10 and after)
kwoodwar at fhcrc.org
MANAGING THE SYMPTOMS OF CHRONIC ACID REFLUX, A RISK FACTOR FOR
BARRETT'S ESOPHAGUS AND ESOPHAGEAL CANCER
More than 20 million Americans experience chronic heartburn, or
gastroesophageal-reflux disease. Of these, between 1 million and 2
million develop Barrett's esophagus, a premalignant condition of the
esophagus, the tube that carries food from the throat to the stomach.
"We know that most cases of Barrett's are caused by long-term, chronic
acid reflux and that reflux probably influences progression of the
condition toward esophageal cancer," said Thomas L. Vaughan, M.D.,
M.P.H., head of the Epidemiology Program and member of the Public Health
Sciences Division of Fred Hutchinson Cancer Research Center in Seattle.
Vaughan and colleagues offer the following suggestions to reduce the
symptoms of acid reflux, a major risk factor for Barrett's esophagus:
* Don't smoke.
* Keep your weight down.
* Get regular exercise.
* Eat a diet rich in fruits and vegetables.
* Refrain from eating four hours before bedtime.
* If you're having heartburn, sleep with the head of your bed
elevated (talk to your doctor about how to do this).
* Avoid foods and beverages that promote heartburn, including
alcohol, caffeine, chocolate, peppermint, onions, green peppers and
foods that are high in fat, all of which can relax the muscle that
prevents stomach acid from washing up into the esophagus.
* Take antacids as needed for occasional heartburn. Talk to your
doctor if you have frequent heartburn or if over-the-counter medications
don't relieve your symptoms.
At Fred Hutchinson Cancer Research Center, our interdisciplinary teams
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information, please visit fhcrc.org.
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
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