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Am J Med. 2019 Jan 23. pii: S0002-9343(19)30076-2. doi: 10.1016/j.amjmed.2018.12.037. [Epub ahead of print]

UNDERUTILIZATION OF ASPIRIN IN PATIENTS WITH ADVANCED COLORECTAL POLYPS.

Author information

1
Cornell University College of Arts and Sciences.
2
Affiliate Associate Professor, Charles E Schmidt College of Medicine, Florida Atlantic University.
3
Assistant Professor, Charles E Schmidt College of Medicine, Florida Atlantic University.
4
Resident in Medicine, Boca Raton Regional Hospital and Charles E Schmidt College of Medicine, Florida Atlantic University.
5
Charles E Schmidt College of Medicine, Florida Atlantic University.
6
Associate Professor, Charles E. Schmidt College of Medicine, Florida Atlantic University.
7
First Sir Richard Doll Professor & Senior Academic Advisor to the Dean, Charles E. Schmidt College of Medicine, Florida Atlantic University, 2800 S. Ocean Blvd. PHA, Boca Raton, FL 33432. Electronic address: chenneke@health.fau.edu.

Abstract

BACKGROUND:

Colorectal cancer is the third most common cause of cancer deaths in the United States and advanced colorectal polyps are a major risk factor. Although there are no large-scale individual trials designed a priori to test the hypothesis, in meta-analyses of trials in primary prevention of cardiovascular disease aspirin reduces risk of colorectal cancer. The United States Preventive Services Task Force utilized a micro-simulation model including baseline risk factors and concluded that aspirin reduces risk of colorectal cancer by 40%. Their guidelines suggest that, without a specific contraindication, clinicians should routinely prescribe aspirin to patients with advanced colorectal polyps.

METHODS:

Written informed consent was obtained and brief telephone interviews conducted by trained interviewers for 84 men and women with biopsy proven advanced colorectal polyps from 55 clinical practices.

RESULTS:

Of the 84, 39(46.4%) were men. The mean age was 66 with a range from 41 to 91 years. Among the 84, 36 (42.9%) reported taking aspirin.

CONCLUSIONS:

These data suggest underutilization of aspirin by patients with advanced colorectal polyps. These data pose major challenges requiring multifactorial approaches by clinicians and their patients which include therapeutic lifestyle changes and adjunctive drug therapies as well as screening. Lifestyle changes include avoidance and treatment of overweight and obesity as well as regular physical activity and adjunctive drug therapies include aspirin. These multifactorial approaches will be necessary to achieve the most good for the most patients concerning prevention as well as early diagnosis and treatment of colorectal cancer in patients with advanced colorectal polyps.

KEYWORDS:

Advanced Colorectal Polyps; Aspirin; Underutilization

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