Aspirin Benefits May Include Cancer Prevention

Regular aspirin use leads to significant reductions in the risk of cancer, metastasis, and cancer mortality, according to one of the largest-ever analyses of published data.

Overall, aspirin users had a 38% reduction in the risk of colorectal and other gastrointestinal cancers compared with nonusers. Cancer mortality was 15% lower among regular users of aspirin, and metastasis was 35% to 40% less common.

One of the analyses showed a reduced risk of vascular events in patients taking aspirin, but an increased risk of major bleeding. The effects of aspirin on both outcomes declined over time. Fatal extracranial bleeding occurred significantly less often among aspirin users, as reported online in three articles in The Lancet and The Lancet Oncology.

The findings “add to the case for long-term use of aspirin for cancer prevention in middle age in addition to appropriate dietary and lifestyle interventions,” Peter M. Rothwell, FMedSci, of the University of Oxford in England, and co-authors concluded in one of their Lancet articles.

“In view of the very low rates of vascular events in recent and ongoing trials of aspirin in primary prevention, prevention of cancer could become the main justification for aspirin use in this setting, although more research is required to identify which individuals are likely to benefit most.”

Despite the comprehensive nature of the analyses, they did not include the two largest clinical evaluations of aspirin’s effect on cancer risk, noted authors of a commentary published simultaneously in The Lancet. The Women’s Health Initiative and the Physicians’ Health Study involved more than 60,000 men and women, and neither demonstrated an effect of aspirin on cancer risk.

Aspirin cuts cancer rates in people with hereditary risk by more than half
Research has finally provided proof that a regular dose of aspirin reduces the long-term risk of cancer in people with a family history of the disease by around 60 per cent.

The international collaboration, including researchers at the Universities of Leeds and Newcastle, reveals that the benefits only become obvious several years after taking the aspirin.

The work is published today in the journal The Lancet.

Evidence of the benefits of aspirin has been accumulating for over 20 years but these are the first results from a randomised controlled trial assessing the effect of aspirin on cancer.

Late last year an analysis of people who had taken part in the early aspirin trials to prevent heart attacks and strokes showed that in subsequent years they developed fewer cancers. The missing piece of the jigsaw was a randomised trial specifically looking at its effect on cancer.

Professor Sir John Burn from Newcastle University, who led the international research collaboration said: “What we have finally shown is that aspirin has a major preventative effect on cancer but this doesn’t become apparent until years later.”

“These caveats notwithstanding, Rothwell and colleagues show quite convincingly that aspirin seems to reduce cancer incidence and death across different subgroups and cancer sites, with an apparent delayed effect,” Andrew T. Chan, MD, and Nancy R. Cook, ScD, of Harvard and Brigham and Women’s Hospital in Boston, wrote. “Thus, for most individuals, the risk benefit calculus of aspirin seems to favor aspirin’s long-term anti-cancer benefit.” In the three articles, the authors described cancer-related outcomes from more than 200 randomized, cohort, and case control studies involving several million patients. The investigators performed multiple analyses, which involved various combinations of the trials. The analysis of cancer mortality encompassed 51 trials (including 34 randomized trials) and more than 100,000 patients. The principal analysis included 34 trials and 69,224 participants. The results showed a mortality odds ratio of 0.85 in favor of aspirin (P=0.008). Considering deaths occurring five years or later into the trials, the aspirin advantage increased to 37% (OR 0.63, P=0.0005). In six trials of low-dose aspirin for primary prevention, cancer incidence was 24% lower with aspirin from 3 years on (P=0.0003) and was significantly lower in both men (OR 0.77, P=0.008) and women (OR 0.75, P=0.01).
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