The cyclooxygenase (COX) pathway has been implicated in carcinogenesis since the 1970s when increased concentrations of prostaglandins were detected in neoplastic tissues, especially colon cancer. Epidemiological studies have documented a decreased incidence of colorectal and breast cancer in patients taking non-specific COX inhibitors such as aspirin and non-steroidal anti-inflammatory drugs (NSAIDs). COX occurs in 2 isoforms: COX-1 is expressed constitutively in most tissues and is thought to serve a function in maintaining the integrity of the gastrointestinal (GI) tract and the renal medulla. COX-2 is in general not detectable in normal tissues and is upregulated in the presence of inflammation and neoplasia. COX-2 is consistently over expressed in a large percentage and variety of human tumors. The presence of elevated COX-2 in tumor tissue represents a poor prognostic factor in a number of tumors including breast cancer
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