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Colorectal polyp outcomes after participation in the seAFOod polyp prevention trial: Evidence of rebound elevated colorectal polyp risk after short-term aspirin use

Lookup NU author(s): Professor Colin Rees



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2023 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.Background: The seAFOod polyp prevention trial was a randomised, placebo-controlled, 2 × 2 factorial trial of aspirin 300 mg and eicosapentaenoic acid (EPA) 2000 mg daily in individuals who had a screening colonoscopy in the English Bowel Cancer Screening Programme (BCSP). Aspirin treatment was associated with a 20% reduction in colorectal polyp number at BCSP surveillance colonoscopy 12 months later. It is unclear what happens to colorectal polyp risk after short-term aspirin use. Aim: To investigate colorectal polyp risk according to the original trial treatment allocation, up to 6 years after trial participation. Methods: All seAFOod trial participants were scheduled for further BCSP surveillance and provided informed consent for the collection of colonoscopy outcomes. We linked BCSP colonoscopy data to trial outcomes data. Results: In total, 507 individuals underwent one or more colonoscopies after trial participation. Individuals grouped by treatment allocation were well matched for clinical characteristics, follow-up duration and number of surveillance colonoscopies. The polyp detection rate (PDR; the number of individuals who had ≥1 colorectal polyp detected) after randomization to placebo aspirin was 71.1%. The PDR was 80.1% for individuals who had received aspirin (odds ratio [OR] 1.13 [95% confidence interval 1.02, 1.24]; p = 0.02). There was no difference in colorectal polyp outcomes between individuals who had been allocated to EPA compared with its placebo (OR for PDR 1.00 [0.91, 1.10]; p = 0.92). Conclusion: Individuals who received aspirin in the seAFOod trial demonstrated increased colorectal polyp risk during post-trial surveillance. Rebound elevated neoplastic risk after short-term aspirin use has important implications for aspirin cessation driven by age-related bleeding risk. ISRCTN05926847.

Publication metadata

Author(s): Downing A, Fenton H, Nickerson C, Loadman PM, Williams EA, Rees CJ, Brown LC, Morris EJA, Hull MA

Publication type: Article

Publication status: Published

Journal: Alimentary Pharmacology and Therapeutics

Year: 2023

Volume: 58

Issue: 6

Pages: 562-572

Print publication date: 01/09/2023

Online publication date: 30/07/2023

Acceptance date: 07/07/2023

Date deposited: 12/09/2023

ISSN (print): 0269-2813

ISSN (electronic): 1365-2036

Publisher: John Wiley and Sons Inc


DOI: 10.1111/apt.17646

PubMed id: 37518954


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Funder referenceFunder name
Efficacy and Mechanism Evaluation Programme