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Long-term aspirin use may reduce gastrointestinal cancer risk
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PHILADELPHIA — Regular, long-term aspirin use was associated with a reduced risk for cancer, especially gastrointestinal cancers, according to prospective study results presented at the American Association for Cancer Research Annual Meeting.
Although previous studies have suggested daily aspirin reduces the overall risk for cancer, data from the Women’s Health study demonstrated alternate-day, low-dose aspirin only reduced the risk for colorectal cancer, according to study background.
“Previous studies of aspirin and cancer have been limited in terms of their size, length of follow-up, or ability to examine aspirin use in the context of other lifestyle factors,” Yin Cao, MPH, ScD, a research fellow in the department of nutrition at Harvard School of Public Health, said in a press release. “Our research provides critical information regarding the full constellation of potential benefits of aspirin use, at a range of doses, timing, and duration of use, within a large population of individuals.”
The analysis included 82,600 female nurses and 47,651 male health professionals enrolled in the 1980 Nurses’ Health Study and the 1986 Health Professionals Follow-Up Study. The researchers collected data on aspirin use, risk factors and cancer diagnosis every 2 years.
After 32 years of follow-up, 27,985 incident cancer occurred (20,414 among women).
Participants who reported taking two or more aspirin tablets per week had a 5% decreased risk for overall cancer (RR = 0.95; 95% CI, 0.93-0.98). This risk reduction was primarily driven by the lower incidence of gastrointestinal cancers (HR = 0.8; 95% CI, 0.75-0.85), including colorectal cancer (HR = 0.75; 95% CI, 0.69-0.81) and gastroesophageal cancer (HR = 0.86; 95% CI, 0.71-1.04).
The risk for non-gastrointestinal cancers did not decrease with regular aspirin use (HR = 0.98; 95% CI, 0.96-1.01), and researchers noted aspirin use was not associated with a reduced risk breast, advanced prostate or lung cancers.
The overall benefit of aspirin on cancer risk appeared to be dose-dependent (P ˂ .001). When compared with the participants who reported no aspirin use, the risks increasingly decreased for participants who used 0.5 to 1.5 aspirin tablets a week (RR = 0.99; 95% CI, 0.95-1.03), 2 to 5 tablets a week (RR = 0.97; 95% CI, 0.93-1.01), 6 to 14 tablets a week (RR = 0.93; 95% CI, 0.89-0.97) and 15 or more tablets per week (RR = 0.94; 95% CI, 0.87-1).
However, the investigators said they did not find a statistically significant risk reduction until 16 years of aspirin use (P = .001). Further, participants who stopped taking aspirin regularly no longer had a significantly reduced risk of cancer after 4 years of discontinuation.
The investigators found no difference in the association of aspirin and cancer risk based on sex, race or ethnicity, familial histories of cancer or diabetes, BMI, a smoking history or regular use of NSAIDs or multivitamins.
“Our findings suggest that for many individuals, the potential benefits of aspirin for the prevention of cancer may actually merit greater consideration than prevention of cardiovascular events,” Andrew T. Chan, MD, MPH, study researcher and associate professor in the department of medicine at Harvard Medical School and the director of the gastroenterology training program at Massachusetts General Hospital, said in a press release, said in a press release. “This strengthens the case for further research into defining subsets of the population that may obtain preferential benefit from regular aspirin use.” – by Anthony SanFilippo
Reference:
Cao Y, et al. Abstract #3197. Presented at: American Association for Cancer Research Annual Meeting; April 18-22, 2015; Philadelphia.
Disclosure: Cao reports no relevant financial disclosures. Chan reported consultant/advisory roles with Bayer, Pfizer and Pozen.
Perspective
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Kirsten Moysich, PhD, MS
The findings by Cao and colleagues confirm some of the previous evidence on the chemopreventive properties of aspirin. Many epidemiological and clinical studies have shown that individuals who use aspirin on a regular basis are less likely to develop cancer, particularly colon cancer. A great strength of this study is that the participants were asked about their aspirin use before they developed cancer. Further, an important contribution of this study relates to the observation that this protection from cancer goes away after aspirin use is discontinued. Aspirin use remains an attractive cancer prevention option, due to the fact that most people will be more likely to take a pill rather than making major lifestyle modifications such as quitting smoking, eating a healthy diet and engaging in physical activity. However, people need to talk to their doctor before starting an aspirin regimen.
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