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Stanford Report, June 4, 2003

Aspirin may lower risk of cancer of esophagus


Medical center researchers who have already proved that expensive anti-inflammatory drugs can inhibit the development of deadly esophageal cancer are now conducting a study to learn whether common aspirin can do the job just as well.

George Triadafilopoulos, MD, has studied why cancer of the esophagus develops far more often in people with acid reflux disease. A professor of medicine, Triadafilopoulos has studied the cellular events that lead to an increased risk of the disease. His research may open the way for finding drugs to halt the progression to cancer.

Regular reflux of stomach acids into the esophagus can lead to chronic inflammation called Barrett’s esophagus. People with Barrett’s esophagus are 100 to 300 times more likely to develop esophageal cancer. "It is a rare cancer, but quite serious when someone does get it because you can’t live without your esophagus," Triadafilopoulos said.

Acid reflux doesn’t lead directly cancer, he noted. Rather, the process of inflammation creates a welcoming place for cancers that do develop. "If a cell flips over and becomes cancerous, it is more likely to thrive in that environment."

Researchers have found that inflammation in the tissues leads to the production of an enzyme called COX-2, which in turn results in the production of prostaglandins. High levels of COX-2 in the esophagus are prime indicators of high cancer risk. Lowering COX-2 levels reduces the formation of precancerous cells, cutting cancer risk.

Triadafilopoulos has been studying how to interfere with the production of COX-2 in Barrett’s esophagus. Last year he published a study of Rofecoxib, a drug that selectively inhibits the production of COX-2. His research showed that Rofecoxib can help inhibit the production of the COX-2 enzyme and inhibiting the occurrence of precancerous cells.

One drawback to Rofecoxib is cost: each pill runs about $2.50, Triadafilopoulos said. Aspirin is also well known as an inhibitor of COX-2 production and should act to lower the risk of cancer in Barrett’s esophagus patients. "The advantage is that an aspirin costs a few pennies," he said.

Triadafilopoulos is now researching whether aspirin is effective in reducing the risk of esophageal cancer. He is looking for patients with Barrett’s esophagus to enroll in a cancer prevention trial. Those who are interested can call him at 493-5000, ext. 64485.

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