Study: daily aspirin can reduce the risk of cancer death

reference

Rothwell PM, Fowkes FG, Belch Jf, Ogawa H, Warlow CP, Meade Tw. Influence of daily aspirin on the long -term risk of dying from cancer: analysis of individual patient data from randomized studies. Lanzette. 2011; 377 (9759): 31-41. Epub 2010, December 6th.

design

Analysis of individual patient data from 8 studies in which aspirin (doses between 75 and 1,200 mg daily) was the interventional treatment that was used in studies to reduce cardiovascular risk. None of the studies were designed to evaluate cancer incidence or cancer -related deaths. Studies have been identified using public databases. All studies were randomized and had an average planned treatment period of at least four years or more. The randomized allocation of Aspirin versus does not include aspirin (no placebo administered) or aspirin versus no aspirin in the presence of another platelet aggregation inhibitor or antithrombolyticism (e.g. warfarin). Long-term data (20 years) were available for three studies that used the United Kingdom's national death and cancer registration systems.

most important findings

The pooled analysis of 8 aspirin studies showed a significant reduction in cancer-related deaths (674 deaths in 25,570 patients; or 0.79, AI 0.68–0.92). p = 0.003). For 7 of the studies available, showed that a benefit was only recognizable after 5 years of follow-up (hr of all types of cancer 0.66, KI 0.5–0.87; GI-CREART HR = 0.46, KI 0.27–0.77; p = 0.003 for both groups of). Data). This latent effect was 5 years for esophageal, pancreatic glands, brain and lung cancer. An even longer latency for a measurable reduction in deaths was found in gastrointestinal, intestinal and prostate cancer. The effect of aspirin was largely limited to adenocarcinomas. The benefits of aspirin did not hug the dose, gender or smoking status. The benefits seemed to gain weight with the age and duration of the aspirin intervention used in the study.

Effects on the practice

Many publications indicate that the intake of Aspirin plays a protective role in cancer of the large intestine, stomach and esophagus. 1.2.3,4 This is the first publication that shows a significant decrease in cancer. In addition to the strong evidence of a protective effect against gastrointestinal cancer, there are supporting information from several observational studies on a reduction in the incidence of prostate, ovarian, lung and brain cancer. Cancer-related deaths as a whole for those who revenue in the long term, by 20 % and especially for cancer of the lower gastrointestinal tract by more than 35 %. These are convincing result data on the use of inexpensive, relatively secure intervention.

There are some important points in this study that are useful for clinicians. First, the benefits of aspirin did not correlate with the dosage used, so that a minimum dose of 75 mg is likely to be sufficient to achieve a benefit. Secondly, the benefit of aspirin was a latent effect, with the reduction of deaths after five years of follow -up. Thirdly, the reduction of deaths correlated with the duration of the aspirin consumption, with longer aspirin intervention correlated with greater benefits. No benefits could be determined in patients who took aspirin for less than 5 years. Finally, a reduction in deaths, especially in people with adenocarcinoma, was found, not in other histological types.

Not all studies have found a protective role of aspirin in cancer. The Nurse 'Health Study, in which 100 mg was taken every second day, showed no reduction in cancer incidence. ^{7 The Physician’s Health Study could show no difference in the development of thick-intestine cancer or adenomes, although this study was only seven Years extended. 8 according to the study cited above, this may not be sufficient, since there was a latency of 10 years to reduce the number of deaths from colon cancer. It seems that aspirin should be taken daily and in a low dose over a longer period of time (longer than 5 years) if there is a benefit to reduce cancer or cancer. This means that people in the forties or fifties may draw more benefits from a longer period of income. As the authors emphasize, there is no evidence of what can be expected after 20 years.}

There is enough indications that inflammatory mediators, including cyclooxygenase-2, are involved in cancer-generating, tumor-generating and metastatic processes. If you consider this study from a broader physiological perspective, Question: "Does the reduction in inflammation through COX-2 inhibition influence the cancer death rate?" Admittedly, it is possible that the effects of aspirin are based on another mechanism, but in view of the proven role of inflammation in carcinogenesis, COX-2 inhibition of aspirin has so far been the alleged mechanism. This is conceptually important because there are many other ways to influence inflammation, many of them without risk for the patient. This includes full value food, selected herbs, fish oil, stress relief and real sleep. To what extent is the anti -inflammatory effect of aspirin a practical replacement for more sensible changes in nutrition and lifestyle? This is a rhetorical question, since the number of disruptive factors that influence the inflammation cannot be taken into account in any study design.

The widespread use of any drug should be considered with great caution. (Pulledquote) While low -dose aspirin has a certain risk of stomach irritation and bleeding, the data in the publication mentioned above is convincing, since this risk appears minimal compared to the advantages for most people. However, the risk of bleeding-in particular gastrointestinal bleeding-should be examined in every patient.

study restrictions

This data comes from studies in which aspirin was originally examined as primary or secondary intervention in cardiovascular diseases/events. The studies were not designed to assess the effects of aspirin on cancer incidence or mortality. In addition, the data is only as good as the source, and in death certificates, cancer can be correctly specified as the cause of death or not. For example, a cancer patient can die from the consequences of the disease or treatment (e.g. infection, stroke) and this complication can be documented as an actual cause of death. Prospective studies are required to underpin the conclusions of the above -mentioned study.

Since all long-term (20-year) data come from British databases, there are some nutritional distortions that may not be applicable to other population groups. The authors admit that "the benefits of aspirin in population groups with a high salicyla intake about food may be lower." The assessment of salicyla intake at the beginning and throughout the study can be helpful in the future.

For further research on integrative oncology, click here Here.