Will a 5-ASA a Day Keep the Cancer (and Dysplasia) Away?

[Guest guest]

Dear All;

In the latest issue of Am. J. Gastroenterology there's an excellent

review of studies showing that 5-aminosalicylic acid (a component of

IBD medications such as Asacol) therapy is good for prevention of

colon cancer in patients with ulcerative colitis:

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Am. J. Gastroenterol. 2005;100:1354–1356

Will a 5-ASA a Day Keep the Cancer (and Dysplasia) Away?

T. Rubin , M.D. 1 and Bret A. Lashner, M.D. 2

Affiliations

1 Section of Gastroenterology, Reva and Logan, Center for

Inflammatory Bowel Disease, The MacLean Center for Clinical Medical

Ethics, University of Chicago

2 Center for Inflammatory Bowel Disease, Cleveland Clinic Foundation,

Cleveland, Ohio

Prevention strategies for colorectal cancer in chronic ulcerative

colitis (UC) are currently based on the identification of neoplasia

by surveillance colonoscopy, but there is a great interest in the

possibility of primary chemoprevention. 5-aminosalicylic acid (5-ASA)

therapy is an attractive option for chemoprevention in UC due to the

fact that it is a derivative of aspirin and has been shown to have a

variety of other molecular and genetic targets of cancer prevention,

but human studies in UC have been limited by observational design and

limited data collection or follow-up. The recently performed

metaanalysis of 5-ASA chemoprevention trials shows a favorable role

of 5-ASA in the prevention of cancer and dysplasia in patients with

UC, and adds to the available evidence favoring its use. This

editorial discusses the substantial logistical and ethical challenges

in designing a randomized double-blind trial to measure the effect of

5-ASA on cancer risk in UC. The authors conclude that the safety and

current maintenance use of 5-ASA warrant its acceptance as a probable

chemopreventive agent at this time.

1. Kornbluth A, Sachar DB . Ulcerative colitis practice guidelines in

adults (update): American College of Gastroenterology, Practice

Parameters Committee. Am J Gastroenterol 2004; 99(7): 1371–85.

2. Allgayer H . Review article: Mechanisms of action of mesalazine in

preventing colorectal carcinoma in inflammatory bowel disease.

Aliment Pharmacol Ther 2003; 18(Suppl. 2): 10–4.

3. Eaden J, Abrams K, Ekbom A, et al . Colorectal cancer prevention

in ulcerative colitis: A case-control study. Aliment Pharmacol Ther

2000; 14(2): 145–53.

4. Rutter M, Saunders B, Wilkinson K, et al. Severity of inflammation

is a risk factor for colorectal neoplasia in ulcerative colitis.

Gastroenterology 2004; 126(2): 451–9.

5. Bernstein CN, Blanchard JF, Metge C, et al. Does the use of 5-

aminosalicylates in inflammatory bowel disease prevent the

development of colorectal cancer? Am J Gastroenterol 2003; 98(12):

2784–8.

6. Velayos FS, Terdiman JP, Walsh JM . Effect of 5-aminosalicylate

use on cancer and dysplasia risk: A systematic review and

metaanalysis of observational studies. Am J Gastroenterol 2005; 100:

1345–53.

7. Kane SV, Cohen RD, Aikens J, et al. Prevalence of nonadherence

with maintenance mesalamine in quiescent ulcerative colitis. Am J

Gastroenterol 2001; 96(10): 2929–33.

8. Eaden J, Abrams K, Ekbom A, et al. Colorectal cancer prevention in

ulcerative colitis: A case-control study. Aliment Pharmacol Ther

2000; 14: 117–20.

9. Eaden JA, Abrams KR, Mayberrry JF . The risk of colorectal cancer

in ulcerative colitis: A meta-analysis. Gut 2001; 48(4): 526–35.

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Best regards,

Dave

(father of (20); PSC 07/03; UC 08/03)