NSAIDs cut risk of oesphageal cancer

NSAIDs could more than halve the risk of aggressive cases of Barrett’s oesophagus progressing to oesophageal cancer, US research suggests.

Patients carrying three or more somatic genetic mutations linked to oesophageal adenocarcinoma risk benefited most.

Checking patients with Barrett’s oesophagus for these biomarkers could identify those at risk of cancer.

Together with subsequent use of NSAIDs, this could be a cost-saving public health strategy, say the researchers.

The study included 243 patients with Barrett’s oesophagus, with an average age of 62, who were assessed for genetic abnormalities and NSAID use.

After 10 years of follow-up, 34 participants had developed oesophageal cancer.

Loss of the short arms of chromosomes 9 and 17 — known to carry genes that inactivate tumour suppressors — was associated with a high risk of developing oesophageal adenocarcinoma. Carrying too many or too few copies of certain chromosomes was also found to be a risk factor.

Patients with these abnormalities have a 79 per cent incidence of oesophageal cancer over 10 years, compared with 12 per cent among those with none.

Sixty-five per cent of the patients were current NSAID users. Among patients with one or more genetic abnormalities, risk of oesophageal cancer was 30 per cent for NSAID users.

For non users of NSAIDs, the risk was 78 per cent. NSAIDs might act by inhibiting cyclo-oxygenase 2, which result in increases apoptosis, while decreasing angiogenesis and proliferation, said the researchers.

Lead researcher Dr Brian Reid, from the Fred Hutchinson Cancer Research Centre in Seattle, said: ‘These findings ultimately may help us identify high-risk patients who truly require frequent surveillance and low-risk patients who need no or less-frequent surveillance.

‘These findings also may help us determine which Barrett’s patients may benefit most from a very cost-effective non-invasive therapy in the form of aspirin or NSAIDs,’ he added.

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