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Aspirin and Nonsteroidal Anti-inflammatory Drugs for the Primary Prevention of Colorectal Cancer: Weighing the Evidence
- Til Stürmer, MD, MPH;
- Julie E. Buring, ScD; and
- Robert J. Glynn, PhD, ScD
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215.
TO THE EDITOR:
The authors of the review papers on aspirin (1) and nonsteroidal anti-inflammatory drugs (NSAIDs) (2) for the primary prevention of colorectal cancer ignore important limitations of observational studies; raise concerns that are unlikely to be valid (1); and fail to include the analysis on NSAIDs from the Physicians' Health Study (PHS) (3), which was published in the interval covered. The authors correctly discuss shortcomings of randomized trials showing no protection in men and women—that is, low dose and short duration (1). They fail, however, to address shortcomings of observational studies on regular long-term drug use—that is, unmeasured confounding—as an alternative explanation for the reduced risk for colorectal cancer observed in most of these studies.
Specifically, regular long-term drug use is associated …
