Aspirin and omega-3 reduce pre-cancerous bowel polyps

Aspirin and omega-3 reduce pre-cancerous bowel polyps

Both aspirin and a purified omega-3, called EPA, reduce the number of pre-cancerous polyps in patients found to be at high risk of developing bowel cancer, according to new research.

A clinical trial found that both aspirin and EPA reduced the number of bowel polyps in patients one year on from a screening colonoscopy (large bowel camera test), although they did not reduce the chances of an individual having any polyps present in the bowel.

Patients who took aspirin developed fewer polyps overall, including on the right side of the large bowel, the part which is most difficult to monitor by colonoscopy being furthest from the back-passage

Patients who took purified omega-3 EPA (eicosapentaenoic acid) also developed fewer polyps, but this effect was seen only on polyps on the left side of the bowel, which is nearest the back-passage.

The seAFOod Trial, the result of a multidisciplinary collaboration between the Universities of Leeds, Nottingham, Bradford and Newcastle, as well as others, is published in The Lancet.

The trial was launched to determine whether aspirin or EPA could reduce the number of people who had any polyps at their one year follow up test, which they did not. However, both compounds had preventative effects by reducing the number of polyps of specific types in patients.

"Given this new evidence, clinicians need to consider these agents for patients at elevated risk of bowel cancer, alongside regular colonoscopy surveillance."

Just over 700 people took part in the study from 53 hospitals in England, all of whom were identified as being at higher risk of developing bowel cancer after having a colonoscopy in the BCSP. This study is the first drug trial to have taken place in the English BCSP.

People who took part were randomly allocated to one of four treatment groups and, each day over the following year, they took either a 300 milligram aspirin tablet; 2 grams EPA in four capsules; a combination of both aspirin and EPA; or placebos only.

Patients who took aspirin had 22% fewer polyps at the end of the one year study compared to those who took the placebo.

Those who took EPA had 9% fewer polyps at the end of the study compared to those who took the placebo, although this difference was not statistically significant. However, patients who took EPA had 25% fewer polyps in the left side of the bowel compared to those who took the placebo.

The study suggests that a 'precision medicine' approach may be the most appropriate way to use aspirin and omega-3 to prevent bowel polyps, in which patients at risk of particular types of polyps are given treatment specific to that risk.

EPA is naturally present in fish oil, but was given to patients at a higher dose than is present in most omega-3 supplements that are available to the public. Aspirin was provided by Bayer AG and EPA was partly provided by SLA Pharma AG.

Although aspirin and EPA had beneficial effects on polyp number on their own, the combination of aspirin and EPA together appeared to have an even greater effect.

However, the trial was not designed to provide a definitive answer about combination treatment and further research is needed to test aspirin and EPA treatment together for polyp prevention.

Treatment with aspirin and EPA was safe with no increased bleeding risk seen. Individuals who took EPA on its own had a slight increase in stomach-upset symptoms.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31775-6/fulltext

http://sciencemission.com/site/index.php?page=news&type=view&id=publications%2Feicosapentaenoic-acid&filter=22

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