13 August 2012

Can daily aspirin help ward off cancer?

A new study bolsters the case that daily aspirin may help protect against cancer, although the effect seems weaker than previously thought.


A new study bolsters the case that daily aspirin may help protect against cancer, although the effect seems weaker than previously thought.

Like earlier research, the new work has considerable limitations.

"News about the cancer potential of aspirin use has been really encouraging lately," said Dr Michael Thun of the American Cancer Society, who worked on the study. "Things are moving forward, but it is still a work in progress."

Aspirin and cancer

Medical guidelines in the US already urge people to take low doses of aspirin to prevent heart disease if the predicted benefits outweigh the risk of side effects, or if they have already suffered a heart attack.

Whether those recommendations should be broadened to include cancer prevention is still up in the air, however.

Earlier this year, an analysis of previous clinical trials showed that people on aspirin were less likely to die of cancer than those not on the medication, with a 37% drop in cancer deaths observed from five years onwards.

How the study was done

The new report, published in the Journal of the National Cancer Institute, is based on a decade's worth of data from more than 100 000 men and women in the US, most over 60 and all of them non-smokers.

People who said they took daily aspirin - whether low-dose or regular strength - had a 16% lower risk of dying from cancer than non-users overall, Dr Thun and his colleagues found.

For men, the difference came out to 103 fewer cancer deaths a year per 100 000 people; for women, the number was 42.

The effect was strongest for gastrointestinal cancers. But it didn't seem to matter whether people had been on aspirin for more or less than five years.

Because the study wasn't a clinical trial, it's hard to know if the findings can be attributed to aspirin or if something else is at play.

Still, Dr Thun said the results would favour broadening the aspirin guidelines to include cancer prevention based on an individual risk-benefit assessment. But he added that it will take scientists a few years to mull over all of the existing evidence. Other researchers are more sceptical. Dr Kausik Ray of St. George's University of London, who has studied aspirin, said the new study did not look at overall death rates or side effects such as serious stomach bleeds.

"This is not a drug without side effects, so what you have to look at is net benefit," he said.

Detection bias

Earlier this year, Dr Ray's team published an analysis of previous aspirin trials showing the medication did not prevent deaths from heart disease or cancer, and was likely to cause more harm than good.

One of the problems with the new study as well as with previous aspirin trials, he said, is detection bias. Patients who develop GI bleeding from aspirin are likely to get worked up by a doctor. As a result, doctors may find and remove tumours or precancerous polyps, which could prolong the patient's life.

So far, most aspirin trials have been designed to test the drug's effect on heart disease. Dr Ray called for trials that specifically check people for new cancers at given intervals to weed out the selection bias marring the previous research.

"I don't think we have enough hard evidence suggesting everybody should be taking" aspirin, Dr Ray said.

The government-backed U.S. Preventive Services Task Force agrees. It discourages the use of aspirin to prevent colorectal cancer in people at average risk for the disease.

(Reuters Health, August 2012)

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