Nonsteroidal antiinflammatory drugs and human cancer. Report of an interdisciplinary research workshop

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Abstract
Background. Since the 1970s, work in several disciplines (toxicology, pharmacology, clinical medicine, epidemiology) increasingly has suggosted that aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) may reduce the occurrence or progression of colorectal cancers and polyps and perhaps of other gastrointestinal tumors. The potential application of these findings for chemoprevention of such cancers in man now deserves serious consideration. Methods. An interdisciplinary workshop was held by the American Cancer Society in March 1994 to review the current knowledge of NSAIDs and cancer and to seek a consensus on future research directions, particularly concerning the possibility of randomized prevention trials in human populations. Results. A wide-ranging review was conducted of past and current research regarding (1) NSAIDs' effects in experimental animal cancer models; (2) clinic experience in NSAID treatment, particularly in familial polyposis; (3) pharmacologic studies regarding the enzymatic and metabolic actions of NSAIDs; and (4) epidemiologic observations on the relationship of aspirin/NSAID usage to colorectal cancer occurrence in human populations. Conclusions. Combined evidence from different research disciplines strongly supports the notion that aspirin and other NSAIDs act to prevent the development or progression of certain human gastrointestinal cancers, especially colorectal cancer. Consequently, the workshop recommended that randomized prevention trials be undertaken. For various logistic reasons, such trials probably should focus on NSAID effects on the occurrence and progression of colorectal polyps rather than on carcinoma itself, Continued research also is needed to clarify further the pharmacologic, clinical, and epidemiologic nature of NSAIDs' influences on human carcinogenesis.