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USPSTF recommends aspirin to prevent colorectal cancer, CVD
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The U.S. Preventive Services Task Force has published a draft recommendation statement that indicates aspirin therapy is a viable approach in the prevention of colorectal cancer and cardiovascular disease.
This marks the first time aspirin has been recommended for cancer prevention by a U.S. medical organization.
Study data show taking regular aspirin for at least 1 decade can help prevent colorectal cancer and reduce the risk for cardiovascular disease (CVD) in individuals at risk for CVD. These guidelines apply to individuals who do not have an increased risk for bleeding, have a life expectancy of at least 10 years and who are willing to take a low-dose aspirin daily.
Age-based guidance
The Task Force recommendations — which are available for public comment through Oct. 12 —include guidance based on age group.
The greatest overall benefit, according to the Task Force, is for individuals aged 50 to 59 years. The Task Force suggested — with a grade B recommendation — individuals in this age group who have a 10% or greater 10-year CVD risk use low-dose aspirin for the primary prevention of CVD and colorectal cancer.
The benefit appears smaller for individuals aged 60 and 69 years, and, thus, the Task Force designated a grade C for low-dose aspirin use in this cohort, which means aspirin use should be determined individually based on their overall health and personal values and preferences.
“Each person has only one decision to make — whether or not to take aspirin for prevention,” Task Force member Douglas K. Owens, MD, MS, director of the center for health policy and the center for primary care and outcomes research at Stanford University, said in a press release. “To help individuals and their clinicians make this decision, the Task Force integrated the evidence about the use of aspirin to prevent cardiovascular disease and colorectal cancer into one recommendation on the use of aspirin.”
The Task Force indicated that there was insufficient evidence to make a recommendation for individuals aged younger than 50 years or aged 70 years or older at this time.
Reviewed evidence
These recommendations were based on a set of evidence-based reviews that were commissioned by the Task Force.
One review showed a potential long-term benefit from aspirin use on colorectal cancer mortality. Pooled data from a set of trials showed that a reduction in long-term mortality appeared possible, but that benefit is not apparent until 10 to 20 years after randomization.
An analysis of three CVD prevention trials showed a 40% reduction in colorectal cancer incidence with aspirin use (RR = 0.6; 95% CI, 0.47-0.76) 10 to 19 years after aspirin initiation.
A pooled analysis of 10 trials showed a 22% reduction in myocardial infarction and coronary events with aspirin (RR = 0.78; 95% CI, 0.71-0.87). This association remained significant when researchers limited the data to eight trials that evaluated low-dose aspirin.
The Task Force indicated that although evidence is evolving regarding the effect of aspirin on other types of cancer, there is currently no sound clinical trial data.
Side effects — such as the potential for hemorrhagic stroke or bleeding in the brain or stomach — should be considered as a risk for regular low-dose aspirin use. Major gastrointestinal bleeding — the most common adverse event associated with aspirin — increased by 59% (OR = 1.59; 95% CI, 1.32.1-91) in seven of the CVD primary prevention trials.
Thus, the decision to use daily aspirin should be evaluated on individual basis between a patient and his or her physician to determine if this approach is safe and efficacious for them, according to the Task Force.
“Taking aspirin is easy, but deciding whether or not to take aspirin for prevention is complex,” Kirstin Bibbins-Domingo, PhD, MD, MAS, vice chair of the Task Force and the Lee Goldman, MD Endowed Chair in Medicine at University of California San Francisco, said in the release. “People aged 50 to 69 should talk with their doctor about their risk of cardiovascular disease and risk of bleeding and discuss whether taking aspirin is right for them.” – by Anthony SanFilippo
Reference:
USPSTF. Draft recommendation statement: Aspirin to prevent cardiovascular disease and cancer. Available at: www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/aspirin-to-prevent-cardiovascular-disease-and-cancer#Pod7. Accessed Sept. 17, 2015.