Benefits of aspirin in cancer prevention outweigh harms
The long-term prophylactic use of aspirin could lead to a dramatic reduction in the incidence of gastrointestinal cancer.
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The long-term prophylactic use of aspirin has a favourable benefit–harm profile and leads to a dramatic reduction in the incidence of bowel, stomach and oesophageal cancer, according to a literature review published in the Annals of Oncology.
To accrue these benefits, aspirin must be taken at a dose of at least 75mg per day for at least five years, and probably for ten years, between the ages of 50 and 65 years, say the study authors, led by John Cuzick from Queen Mary University of London.
“While there are some serious side effects that can’t be ignored, taking aspirin daily looks to be the most important thing we can do to reduce cancer after stopping smoking and reducing obesity, and will probably be much easier to implement, ” said Cuzick in a press statement.
Cuzick’s team searched the literature for studies reporting the benefits and harms of prophylactic aspirin use in the general population. They found “overwhelming” evidence for a reduction in incidence and mortality from colorectal cancer from regular aspirin use, as well as evidence for reductions in incidence and mortality from oesophageal and gastric cancer.
Other benefits of aspirin use include protection against lung, prostate and breast cancer, and a reduction in serious vascular events, particularly non-fatal myocardial infarction.
Bleeding is the most important side effect of aspirin, of which haemorrhagic stroke is the most serious manifestation; the relative risk is increased by between 32% and 36% in aspirin users from a baseline rate of 0.03% per year.
“Using our ‘best estimates’ for individuals taking aspirin for ten years, there would be a ‘relative’ reduction of 9% in the number of men and 7% in the number of women with a cancer, myocardial infarction or stroke event over a 15-year period,” the researchers write.
The optimum aspirin dose and duration of use remains in doubt, they add, as does the best way to identify individuals at increased risk of bleeding, including minor bleeding events.
“These events have an important influence on acceptability and adherence, and research to gather such data are needed,” the team writes.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20066114