Author(s): Logan RF, Grainge MJ, Shepherd VC, Armitage NC, Muir KR ukCAP Trial Gr
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Abstract BACKGROUND & AIMS: Although observational studies have found regular aspirin use to be associated with a reduced risk of colorectal neoplasia, results from randomized trials using aspirin have been inconsistent. Dietary folate intake also has been found to be associated with a reduced risk of colorectal neoplasms in observational studies. METHODS: A multicenter, randomized, double-blind trial of aspirin (300 mg/day) and folate supplements (0.5 mg/day) to prevent colorectal adenoma recurrence was performed using a 2 x 2 factorial design. All patients had an adenoma (>/=0.5 cm) removed in the 6 months before recruitment and were followed-up at 4-month intervals with a second colonoscopy after approximately 3 years. The primary outcome measure was a colorectal adenoma diagnosed after baseline. RESULTS: A total of 945 patients were recruited into the study, of whom 853 (90.3\%) underwent a second colonoscopy. In total, 99 (22.8\%) of 434 patients receiving aspirin had a recurrent adenoma compared with 121 (28.9\%) of 419 patients receiving placebo (relative risk, 0.79; 95\% confidence interval [CI], 0.63-0.99). A total of 104 patients developed an advanced colorectal adenoma; 41 (9.4\%) of these were in the aspirin group and 63 (15.0\%) were in the placebo group (relative risk, 0.63; 95\% CI, 0.43-0.91). Folate supplementation was found to have no effect on adenoma recurrence (relative risk, 1.07; 95\% CI, 0.85-1.34). CONCLUSIONS: Aspirin (300 mg/day) but not folate (0.5 mg/day) use was found to reduce the risk of colorectal adenoma recurrence, with evidence that aspirin could have a significant role in preventing the development of advanced lesions.
This article was published in Gastroenterology
and referenced in Journal of Cancer Science & Therapy