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3 February 2004 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians, an organization of more than 115,000 internal medicine physicians and medical students. These highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.

Study Suggests that Higher Doses of Aspirin May Prevent Colorectal Cancer

--Research needed to identify those for whom benefit could outweigh risk of side effects

A study of 27,077 women found that those who took higher doses of aspirin seem to have lower risk for developing adenomas (a type of polyp that can become colorectal cancer) than those who reported never using or rarely using aspirin. The women had no known history of colon disease at the start of the study and had a colonoscopy or sigmoidoscopy between 1980 and 1998. Overall, 1,368 cases of distal colorectal adenoma were diagnosed. Women who reported taking up to 14 tablets per week had the lowest relative risk for this cancer. Women who reported never using or rarely using aspirin had the highest relative risk. Authors caution that while low doses of aspirin seem to prevent heart disease, higher doses increase risks for adverse effects such as gastrointestinal bleeding, so people should not take higher doses of aspirin to prevent colorectal adenomas until more studies clearly define the overall benefits and harms of these doses. Screening with colonoscopy and sigmoidoscopy remains the best way to prevent colon cancer. (NOTE: This article is the subject of a video news release. Call for coordinates and/or copy of script.)

Publication of Clinical Trial Results on Hormone Therapy Lowered Use

Release of data from two long-term studies of hormone therapy was followed by decline in use of HT. Release of the HERS data in 1998, finding that taking HT did not protect against heart disease, was temporally associated with a modest decline in use of HT. (Before publication of HERS, the use of HT was about 41% in the study group and was increasing at a rate of 1% per quarter. After publication, use decreased by 1% per quarter.) Termination of one arm of the WHI study in 2002, finding that women who took HT actually had a higher risk for heart disease and breast cancer than those who did not take HT, was followed by a more substantial decline in use of HT (18% per quarter). Researchers looked at the use of HT before and after the results of the two trials were published among women in San Francisco who had mammograms between 1997 and 2003. The study did not answer why this decline occurred, but authors and editorial writers surmise that the widespread news coverage, especially after termination of the WHI study, was responsible for informing both physicians and patients and resulted in rapid change in medical practice.

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