Aspirin use protects against bile duct cancer
Patients using aspirin are up to 3.6 times less likely to develop cholangiocarcinoma (CCA) compared with those unexposed to the drug, according to a recent US cohort study.
Researchers examined data from 2,395 patients with CCA (n=1,169 intrahepatic; n=995 perihilar; n=231 distal) treated at Mayo Clinic from 2000 through 2014. Cases were matched with controls 1:2 by age, sex, race, and residence (n=4,769).
Of the subjects, 24.7 percent in the CCA group and 44.6 percent in the control group took aspirin. Aspirin use was inversely linked to CCA subtypes (p<0.001), with adjusted odds ratios [AORs] of 0.35 (95 percent CI, 0.29 to 0.42) for intrahepatic, 0.34 (0.27 to 0.42) for perihilar, and 0.29 (0.19 to 0.44) for distal CCA.
Primary sclerosing cholangitis (PSC) had stronger association with perihilar (AOR, 452.9; 104 to 999) than intrahepatic (AOR, 93.4; 27.1 to 322.2) or distal CCA (AOR, 34; 3.6 to 323.1). Diabetes had higher correlation with to distal (AOR, 4.2; 2.5 to 7.0) than perihilar (AOR 2.9; 2.2 to 3.8) or intrahepatic CCA (AOR 2.5; 2 to 3.2).
Non-PSC related cirrhosis was associated with both intrahepatic and perihilar CCA with similar AORs of 14. Isolated inflammatory bowel disease without PSC was not associated with any CCA subtype.
Bile duct cancer is an uncommon cancer that forms in the slender tubes (bile ducts) that carry digestive fluid through the liver. The disease occurs mostly in people over 50 and can cause symptoms, such as yellowing of the skin and eyes, intense itchiness of the skin, and white stools. Bile duct cancer is an aggressive type of cancer that progresses quickly and is difficult to treat.
The protective effects of aspirin use against cancer of the bile ducts may be mediated by the drug’s inhibition of the enzyme cyclo-oxygenase (COX) known to promote inflammation. Unremitting inflammation is one of the main factors that promotes cancer of the bile ducts.
Aside from obstructing the COX enzyme pathway, aspirin could block additional cell-signalling cascades that promote cancer development, particularly gastrointestinal cancer.
Further studies are required to validate the safety and efficacy of aspirin use in the prevention of bile duct cancer, researchers said.