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European Journal of Epidemiology

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Open Access 15-06-2023 | Colorectal Cancer | GASTRO-INTESTINAL DISEASES

Target trial emulation of aspirin after diagnosis of colorectal polyps

Authors: Louise Emilsson, Mingyang Song, Jonas F. Ludvigsson

Published in: European Journal of Epidemiology | Issue 10/2023

Abstract

Backgound and Aims

Previous research on the potential chemoprotective effect of aspirin for colorectal cancer (CRC) shows conflicting results. We aimed to emulate a trial of aspirin intiation in individuals with incident polyps.

Methods

We identified individuals registered with their first colorectal polyp in the nationwide gastrointestinal ESPRESSO histopathology cohort in Sweden. Individuals aged 45–79 years diagnosed with colorectal polyps 2006–2016 in Sweden without CRC or contraindications for preventive aspirin (cerebrovascular disease, heart failure, aortic aneurysms, pulmonary emboli, myocardial infarction, gastric ulcer, dementia, liver cirrhosis, or any other metastatic cancer) registered until the month of first polyp detection were eligible. Using duplication and inverse probability weighting, we emulated a target trial of aspirin initiation within 2 years of initial polyp detection. The main outcome measures were incident CRC, CRC mortality and all-cause mortality registered until 2019.

Results

Of 31,633 individuals meeting our inclusion criteria, 1716 (5%) initiated aspirin within 2 years of colon polyp diagnosis. Median follow-up was 8.07 years. The 10-year cumulative incidence in initiators versus non-initiators was 6% versus 8% for CRC incidence, 1% versus 1% for CRC mortality and 21% versus 18% for all-cause mortality. The corresponding hazard ratios were 0.88 (95% confidence interval, 95%CI = 0.86–0.90), 0.90 (95%CI = 0.75–1.06) and 1.18 (95%CI = 1.12–1.24).

Conclusion

Aspirin initiation in individuals with polyp removal was linked to 2% lower cumulative incidence of CRC after 10 years but did not alter CRC mortality. We also observed a 4% increased risk difference of all-cause mortality at 10 years after the initiation of aspirin.

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Title: Target trial emulation of aspirin after diagnosis of colorectal polyps
Authors: Louise Emilsson
Mingyang Song
Jonas F. Ludvigsson
Publication date: 15-06-2023
Publisher: Springer Netherlands
Keywords: Colorectal Cancer
Colorectal Cancer
Published in: European Journal of Epidemiology / Issue 10/2023
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI: https://doi.org/10.1007/s10654-023-01024-1

2024 ASCO Annual Meeting

Springer Medicine

Target trial emulation of aspirin after diagnosis of colorectal polyps

Abstract

Backgound and Aims

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Backgound and Aims

Methods

Results

Conclusion

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