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Regular aspirin use reduced risk for pancreatic cancer
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Regular aspirin use was associated with a dramatically reduced risk for pancreatic cancer, and the benefits appeared greatest among long-term aspirin users, according to study results.
“The use of low-dose aspirin was associated with cutting the risk of pancreatic cancer in half, with some evidence that the longer low-dose aspirin was used, the lower the risk,” researcher Harvey A. Risch, MD, PhD, professor of epidemiology in the Department of Chronic Disease Epidemiology at the Yale School of Public Health, said in a press release. “Because about one in 60 adults will get pancreatic cancer and the 5-year survival rate is less than 5%, it is crucial to find ways to prevent this disease.”
Harvey A. Risch
Risch and colleagues evaluated data from a population-based study conducted in Connecticut between 2005 and 2009. The analysis included 362 individuals with pancreatic cancer, as well as 690 randomly sampled controls who were matched for age and gender.
Participants in both cohorts completed interviews about previous aspirin use. Researchers defined a low-dose aspirin regimen as 75 mg to 325 mg daily, typically for heart disease prevention. They defined a regular-dose aspirin regimen as >325 mg to 1,200 mg every 4 to 6 hours, typically to reduce pain or inflammation.
Researchers defined regular use as taking aspirin at least once a week for ≥3 months. Ninety-six percent of participants who identified themselves as low-dose aspirin users and 92% of those who identified themselves as regular-dose aspirin users indicated they took aspirin daily.
Overall, regular use of aspirin was associated with a 48% reduction in risk for pancreatic cancer compared with never use (OR=0.52; 95% CI, 0.39-0.69).
Researchers observed reduced pancreatic cancer risk for each cumulative year of any aspirin use (OR=0.97; 95% CI, 0.95-0.99), each cumulative year of low-dose aspirin use (OR=0.94; 95% CI, 0.91-0.98) and each cumulative year of regular aspirin use (OR=0.98; 95% CI, 0.96-1.01).
When researchers stratified data according to duration of use, the reduction in risk for pancreatic cancer ranged from 48% among individuals who reported ≤3 years of low-dose aspirin use (OR=0.52; 95% CI, 0.28-0.97) to 61% among those who reported >20 years of use (OR=0.39; 95% CI, 0.13-1.17).
“Older studies of aspirin use have been clouded by the use of [regular- or high-dose] aspirin for pain relief from conditions that themselves might be related to the risk for pancreatic cancer,” Risch said. “Only recently have people been using low-dose aspirin for long enough times [to prevent cardiovascular disease] that the use might bear on risk of pancreatic cancer development. There seems to be enough evidence that people who are considering aspirin use to reduce the risk for cardiovascular disease can feel positive that their use might also lower their risk for pancreatic cancer, and quite certainly wouldn’t raise it.”
However, the cessation of aspirin use 1 to 2 years prior to the study period was associated with an increased risk for pancreatic cancer compared with continuous use (OR=3.24; 95% CI, 1.58-6.65).
“Aspirin use has potential risks of its own, and thus the risks and benefits for each person have to be evaluated based on personal characteristics and considerations,” Risch said. “For the small subset of individuals with strong family histories of pancreatic cancer or who otherwise have been evaluated to be at substantially increased risk of pancreatic cancer, aspirin use could be part of a regimen designed to reduce their risk.”
Disclosure: The study was funded by the NCI. The researchers report no relevant financial disclosures.
Perspective
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Katherine Van Loon, MD, MPH
Pancreatic cancer is a disease that is notable for relatively limited and sometimes conflicting data on modifiable risk factors. Thus, the results reported by Streicher and colleagues supporting the long-term use of aspirin as a possible strategy to reduce the risk of pancreatic cancer may represent an exciting step forward. In particular, the finding of a duration-response benefit is notable and may explain the inconsistent findings reported in the historic literature on this topic.For individuals and families who are known to be at an increased risk for the development of pancreatic cancer, identification of a modifiable risk factor could be particularly meaningful. For example, individuals with particular genetic syndromes (eg, Peutz-Jeghers syndrome, hereditary pancreatitis, BRCA2 mutation or familial atypical multiple mole melanoma) or those who are part of families with clustering (ie, two or more first-degree relatives with pancreatic cancer) have a relative lifetime risk for developing pancreatic cancer ranging from 3.5% to as high as 80%. Focused inquiry on chronic aspirin as chemoprophylaxis, as well as appropriate dosing and duration of therapy, in these high-risk subgroups is warranted.
For now, these findings are not quite ready for extrapolation to clinical practice for prevention of pancreatic cancer in the general population. However, this report certainly adds to the growing body of literature that, in sum, points to a pleiotropic benefit of chronic aspirin exposure. For an almost uniformly lethal disease such as pancreatic cancer, the risks vs. benefits of chronic aspirin exposure for prevention deserves further analysis.
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