I vaguely remember taking aspirin when I was sick as a kid. I think baby aspirin back then was pink and came in a small glass bottle. By the time I had children though, it was no longer recommended. The use of aspirin was associated with serious complications and easy enough to substitute with other medicines. While banned from my medicine cabinet, I was still aware of its use in the treatment of heart disease and stroke. But recently it has been popping up in the news in relation to another life-threatening disease: cancer.
As an interested party, since I was recently diagnosed with breast cancer, this caught my immediate attention. The possibility that such an inexpensive, everyday drug could be used against cancer seems too good to be true. But after reading conflicting reports, I wondered if I should burst my bubble of optimism. What is the real deal with aspirin?
LOOKING INTO ASPIRIN
One of the world’s top aspirin researchers, Professor Peter Rothwell of Oxford University, analyzed the trials originally carried out for the prevention of heart attacks and stroke, to evaluate the drug’s impact on cancer. His findings, published in three separate studies in The Lancet, are surprising:
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A daily dose of aspirin reduced the risk of cancer death by 15%, with prolonged use resulting in an even greater reduction of up to 37% after 5 years.
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Cancer incidence was also cut by aspirin use, with a 23% lower incidence in men and 25% in women after only 3 years of aspirin therapy.
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After six and a half years of use, aspirin reduced the risk of metastasis, or cancer spreading to other organs, by 36% regardless of age or gender.
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Aspirin use seemed to have a greater effect in preventing the spread of adenocarcinomas, or solid tumors, which include colorectal cancer, most breast and prostate cancers and some types of lung cancer.
Based on these findings, the benefits of aspirin therapy may be greater for cancer than for heart disease or stroke, according to some experts. So, should I start a daily dose ASAP? It is not that simple. Taking aspirin regularly entails serious risks, with abdominal bleeding at the top of the list. The delicate balance of benefits versus risks has doctors divided. Opinions in favor and against were heard at the recent Congress of the European Society of Medical Oncology.
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Arguments in favor of using aspirin as chemoprevention (drugs used to prevent the development of cancer) cite the studies that show significant impact on incidence rates and death rates. Experts against immediate application of aspirin therapy argue that the majority of the population would not benefit from its use. Instead, these researchers propose identifying those patients who will gain the most from aspirin therapy, but will not suffer side effects.
VERY REAL BENEFITS
A step in this direction was achieved by a study conducted at the Dana-Farber Cancer Institute and published in the New England Journal of Medicine this past October. This research revealed aspirin therapy resulted in significant improvements in survival for colorectal patients with a specific gene mutation. Aspirin is now being recommended for colon cancer patients, but it seems especially effective for the 20% of cases with the PIK3CA mutation.
Experts say this does not rule out benefits for the remaining types of colon cancer, just like they haven’t ruled out the benefits of aspirin use in the treatment and prevention of other cancers. Numerous studies in the United States and Europe provide new evidence of the drug´s protection against skin, prostate and ovarian cancer, as well as Barrett’s Esophagus, a precursor of throat cancer. While aspirin is singled-out as the only pain medication with anti-cancer properties, the authors concur in recommending that larger studies are necessary to understand its impact on cancer.
According to the American Cancer Society, any decision concerning aspirin treatment should be made on a case by case basis in consultation with your healthcare professional. I did just that and checked with my oncologist during my last visit; she didn’t recommend it for breast cancer just yet. If you think you may benefit from taking a daily dose of aspirin, don’t hesitate to ask your primary care physician, especially if you have a family history of colon cancer.
GUIDELINES FOR ASPIRIN USE
In the future, guidelines regarding daily aspirin therapy will most certainly consider its impact on cancer as well as on heart attack and stroke risk. In the meantime, the U.S. Preventative Services Task Force recommends aspirin therapy for men between the ages of 45 and 79 when the potential benefit for lowering heart attacks outweighs the risks; and for women between the ages of 55 to 79 when the potential benefit for lowering strokes outweighs the risks.
The risks of regular aspirin use include abdominal bleeding, stomach ulcers and intracranial hemorrhage. Plus potentially dangerous interactions with other drugs that can cause this side effect including, anticoagulants or blood thinners, cortico-sterioids, some antibiotics and even other pain relievers (such as ibuprofen or naproxen). Aspirin should be taken with food, to prevent stomach irritation, and never in combination with alcohol.
The active ingredient in aspirin, salicylate, which is derived from willow bark, is believed to be one of the oldest drugs in the world, with first reports of its use dating back to an Egyptian papyrus in 1543 BC.
