A prospective analysis of women under 50 found regular intake of aspirin or other NSAIDs at least twice a week may lower the risk for early-onset adenomas.

Early-onset colorectal cancer is increasingly prevalent, especially among people younger than 50. At DDW 2023, Cassandra Fritz, MD, presented a prospective analysis of 32,058 women younger than 50 years who underwent at least one lower gastrointestinal endoscopy between 1991 and 2015. The study classified high-risk adenomas by size, histology, high-grade dysplasia, or the presence of 3 or more adenomas. As a secondary objective, late-onset adenomas were also evaluated.

Among the 1,247 early-onset adenomas identified, 290 were high-risk. After adjusting results for risk factors (BMI, family history of colorectal cancer, and other comorbidities), regular intake of aspirin or NSAIDs was associated with a lower adenoma risk (OR, 0.85; 95% CI, 0.75-0.95). This association was held for both high and low-risk adenomas, regardless of size. However, a higher risk reduction was seen for tubulovillous adenomas or those with high-grade dysplasia (OR, 0.67; 95% CI, 0.51-0.89) compared with tubular adenomas (OR, 0.90; 95% CI, 0.79-1.03).

For late-onset adenomas, the greatest risk reduction was primarily found in large adenomas (OR, 0.76; 95% CI, 0.62-0.93) or multiple adenomas (OR, 0.57; 95% CI, 0.4-0.83) but not in advanced histology adenomas (OR, 0.92; 95% CI, 0.73-1.17).

The results highlight the urgent need to evaluate aspirin and other NSAIDs as chemopreventive agents for early-onset colorectal cancer. Future studies should consider various patient demographics, appropriate treatment dosage, duration, and potential side effects in young adults.

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