Doctors from around the UK are investigating whether the humble aspirin can be used to prevent cancer of the foodpipe – known as oesophageal cancer.
The drug is being used with an anti-ulcer drug to try to prevent a condition called Barrett’s oesophagus from developing into oesophageal cancer.
Barrett’s oesophagus affects up to two per cent of the UK population and is responsible for around half of all oesophageal cancers. Patients with the condition have stomach acid that rises from the stomach into the oesophagus usually causing frequent heartburn. The acid damages the cells in the lining of the oesophagus and in some cases they turn cancerous.
The Cancer Research UK funded trial* aims to see if aspirin and the anti-ulcer drug can prevent this condition of the oesophagus worsening and its progression to cancer. The number of cases of oesophageal cancer has climbed quickly in recent years – increasing more than 10 per cent over the last decade. There are over 7,000 cases in the UK every year. Deaths from oesophageal cancer are increasing as the number of new cases rises.
The trial is one of the largest cancer prevention trials in the world, now with 5000 men and women who have Barrett’s oesophagus being recruited for the trial from over 50 UK centres. Previously the trial was only open to men.
Professor Janusz Jankowski, lead researcher based in the department of clinical pharmacology at Oxford’s Radcliffe Infirmary, said: “Only a small proportion of those with Barrett’s oesophagus will develop oesophageal cancer but an increasing number of people in the UK are developing this cancer. Cases of oesophageal cancer are high in the UK compared to the rest of the western world, at three to four times the level seen in Europe or the US.
“This research should provide us with valuable knowledge on how to prevent oesophageal cancer. Anyone who has Barrett’s oesophagus and would like more information should call 02070618355.”
The researchers will use combinations of aspirin and a drug called esomeprazole to treat Barrett’s oesophagus. Aspirin is an anti-inflammatory drug and it is thought this property may reduce the chances of the Barrett’s cells to turn cancerous. Esomeprazole works as an anti-ulcer drug by reducing the amount of acid produced by the stomach. A high dose of esomeprazole may also minimise damage to the lining of the oesophagus and promote healing – helping to prevent cells becoming cancerous.
One of aspirin’s side effects is an increased risk of stomach ulcers and it is hoped that esomeprazole will minimise this risk. People with Barrett’s oesophagus are also more likely to suffer from heart problems – another area where aspirin has been shown to be of benefit.
Those who take part in the trial will receive one of four different combinations of the drugs for up to eight years: aspirin and a high dose of esomeprazole; a high dose of esomeprazole but no aspirin; aspirin and a lower dose of esomeprazole; or a lower dose of esomeprazole but no aspirin. Each drug is taken as a daily tablet.
Professor Janusz Jankowski added: “The UK is at the epicentre of researching new ways to tackle this cancer. We hope these drugs will offer a simple method of preventing this particularly aggressive form of the disease.
“We are at the crucial stage of recruiting men and now women with Barrett’s oesophagus to this important trial. These people will not only get the best possible care, they will also help uncover key clues in the fight against cancer.”
Professor John Toy, medical director at Cancer Research UK, said: “Preventing cancer is a major focus for Cancer Research UK. This large trial may be the first step towards a way to prevent many cases of a cancer that kills over 7000 people a year in the UK. It’s an opportunity to reverse the trend and close the stable door before the horse has bolted.”
For more information about the trial and how to join please contact Cancer Research UK’s cancer information nurses on 02070618355.
For media enquiries please contact Paul Thorne in the Cancer Research UK press office on 02070618352 or the out of hours on 07050264059.
*The trial’s full name for men is ‘ASPECT: Aspirin Esomeprazole Chemoprevention Trial’ and for women is ‘WASP: Womens Aspect Study Protocol’. Further details can be found on Cancer Research UK’s patient information web site CancerHelp UK.
You cannot enter this trial if you:
- Have severely abnormal cells in the lining of your oesophagus
- Have oesophageal cancer
- Have any other serious medical condition
- Already take aspirin or another non steroidal anti inflammatory drug (NSAID)
- Are unable to take aspirin
- Do not live in the UK
There are a number of symptoms of oesophageal cancer. Many of these can be caused by conditions other than oesophageal cancer, but it is important that you report them to your doctor. They can include:
- Difficulty swallowing
- Weight loss
- Pain or discomfort in the throat or back, behind the breastbone or between the shoulder blades
- Acid indigestion
- Hoarseness or chronic cough
- Vomiting or regurgitation of blood
Heartburn or gastro-oesophageal reflux disease (GORD) affects 30 per cent of the population in Western countries. In a third of these individuals the damage to the oesophagus caused by the backing up of stomach acid causes erosive oesophagitis. It is those with erosive oesophagitis that have a 10 per cent chance of developing Barrett’s oesophagus.
The incidence rate of Barrett’s oesophagus in the UK may be among the highest in the world with between 0.5 and 2 per cent of adults suffering from the condition, however, the true prevalence of this condition in the population is not known. The resulting level of oesophageal cancer in some parts of the UK is 3-4 times higher than in Europe or North America.
Barrett’s oesophagus – the cells lining the oesophagus start to change to look more like the cells lining the stomach. The condition may develop following long-term acid reflux from the stomach. The stomach acid comes back up into the oesophagus and irritates the lining. 30 per cent of the population will have regular heartburn each month but only one per cent of the population will have Barrett’s oesophagus.
People with Barrett’s oesophagus are 50 times more likely to develop cancer of the oesophagus than the average person.
The overall risk to any individual of getting oesophageal cancer is quite small. The risk with Barrett’s oesophagus may be 50 times higher, but still represents a relatively small risk. Less than one out of every 100 people with Barrett’s oesophagus will go on to get oesophageal cancer each year. Since Barrett’s oesophagus is diagnosed late in life usually after 60 years of age, the lifetime cancer risk for affected men is no more than 5-10 per cent and less than this for women.
Less than 10 per cent of those diagnosed with oesophageal cancer survive for more than 5 years and one year survival is less than 50 per cent.
Esomeprazole is a ‘proton pump inhibitor’. It works by blocking the production of stomach acid. These drugs are used to heal stomach and duodenal ulcers. Astra Zeneca manufactures the drug.
Previous studies have suggested that aspirin can reduce a person’s risk of developing oesophageal cancer. This is thought to be because aspirin is an anti-inflammatory drug. It can dampen down the inflammation caused by Barrett’s oesophagus. Short-term inflammation is the body’s natural reaction to damage and aids the healing process. Low-level, long-term inflammation may play an important role in increasing the risk of cancer.
Aspirin can also act to prevent heart attacks in those at high risk of heart attack as well as prevent oesophageal cancer.