07 May Could Aspirin Improve Stool Testing for Colon Cancer Screening?
MedicalResearch.com Interview with:
Prof. Dr. med. Hermann Brenner
Clinical Epidemiology and Aging Research
German Cancer Research Center
Foundation under Public Law
MedicalResearch.com: What is the background for this study?
Response: Colorectal cancer is the third most common cancer globally, accounting for almost 900.000 deaths every year. Most of these deaths could be prevented by screening colonoscopy with early detection and removal of precursors of the cancer. However, capacities and use of screening colonoscopy are limited in most parts of the world, and low-cost but reliable noninvasive screening tests are important alternative primary screening tests.
The currently best established noninvasive tests are fecal immunochemical tests for hemoglobin (FITs) which are offered for colorectal cancer screening in an increasing number of countries. Although FITs detect the majority of colorectal cancers they detect approximately one out of four advanced adenomas only, the precursors of most colorectal cancers.
We hypothesized that this proportion could be increased by taking a single pill of aspirin two days prior to collecting the stool sample for FIT, because the well-established antithrombotic effects of aspirin might favor detecting occult bleeding from colorectal cancer or its precursors.
MedicalResearch.com: What are the main findings?
Response: To test this hypothesis, a multi-center double-blind randomized clinical trial was done among 2422 participants of screening colonoscopy in Germany who were asked to provide a fecal sample for fecal immunochemical tests prior to bowel preparation for colonoscopy. Participants were asked to take a single pill containing either 300 mg aspirin or placebo two days before fecal sample collection. Detection rates of advanced neoplasms (i.e., either colorectal cancer or advanced adenoma) by FIT, which were determined by comparison of FIT results with findings at colonoscopy, were approximately one third higher in the intervention than in the placebo group.
The difference did though not reach statistical significance (p=0.14), given the limited number of participants with advanced neoplasms in the study (n=224 overall)
MedicalResearch.com: What should readers take away from your report?
Response: Although they did not reach statistical significance, the findings support suggestions that a measure as simple, low risk and inexpensive as taking a single low dose of aspirin prior to fecal immunochemical tests testing may substantially enhance the efficacy of FIT based colorectal cancer screening.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Further studies should be conducted with larger sample sizes, and they should also aim for optimizing timing, dosage and target groups of aspirin use prior to fecal sampling for fecal immunochemical tests.
MedicalResearch.com: Is there anything else you would like to add?
Response: This study was conducted in the context of the German Cancer Consortium which is funded by German Federal Ministry of Education and Research.
Brenner H, Calderazzo S, Seufferlein T, et al. Effect of a Single Aspirin Dose Prior to Fecal Immunochemical Testing on Test Sensitivity for Detecting Advanced Colorectal Neoplasms: A Randomized Clinical Trial. JAMA.2019;321(17):1686–1692. doi:10.1001/jama.2019.4755
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