Re: Cancer and aspirin - Aspirin as Cancer Prevention Pill Still a Long Way Off
- From: Matti Narkia <mna@xxxxxxxx>
- Date: Mon, 14 May 2007 01:37:52 +0300
On Sun, 13 May 2007 16:30:52 -0400, J <nexsw@nvalid,anon> wrote:
The above mentioned Jacobs et al. study is an epidemiological study,
?The American Cancer Society does not recommend using aspirin to prevent
cancer because aspirin can cause serious gastrointestinal bleeding,? said
Dr. Jacobs. ?Recommendations for aspirin use should continue to be based
on prevention of heart disease and stroke, not cancer. However if further
research confirms that daily adult-strength aspirin can meaningfully
reduce cancer risk, future recommendations could take cancer prevention
into account when deciding on the best dose for people who already need to
take aspirin to prevent cardiovascular disease.?
Article: Jacobs EJ, Thun MJ, Bain EB, Rodriguez C, Henley SJ, Calle EE. A
Large Cohort Study of Long-Term Daily Use of Adult-Strength Aspirin and
Cancer Incidence. J Natl Cancer Inst 2007; 99: 608-615
<
http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Long-term_Aspirin_Use_Linked_to_Lower_Cancer_Risk.asp
Long-term Aspirin Use Linked to Lower Cancer Risk
But Aspirin as Cancer Prevention Pill Still a Long Way Off
Article date: 2007/04/18
Summary: A large analysis by American Cancer Society researchers suggests
that daily long-term use of adult-strength aspirin may reduce cancer risk
by about 15% in both men and women. But don't start popping pills yet.
Aspirin can cause serious side effects, and the evidence for cancer
prevention isn't strong enough yet to justify a recommendation, the
researchers caution.
which predates the study
Flossmann E, Rothwell PM
Effect of aspirin on long-term risk of colorectal cancer: consistent
evidence from randomised and observational studies
The Lancet, May 12, 2007; vol 369: pp 1603-1673.
DOI:10.1016/S0140-6736(07)60747-8.
<http://www.thelancet.com/journals/lancet/article/PIIS0140673607607478/abstract>
which I mentioned earlier. Therefore at the time of the writing of the
Jacobs et al. article neither Jacobs et al. nor ACS were aware of the
results of this Flossmann and Rothwell Lancet study. However, even
Jacobs et al. found that the use full-dose aspirin for <= 12 years was
associated with statistically significant 32% reduction in colorectal
cancer risk. This was less than the 74% reduction in Flossmann and
Rothwell Lancet study, but the observation period was also shorter
than in Flossmann and Rothwell Lancet study, which found that the
maximum reduction was achieved with at least five years use after 10
years latency period, i.e. after at least 15 years of use of full-dose
aspirin. Also, Flossmann and Rothwell article was largely based on
two large randomised controlled trials with reliable post-trial
follow-up for more than 20 years. Therefore, unlike Jacobs et al.,
whose study was epidemiological, Flossmann and Rothwell were able to
draw definite causal conclusions, and not only present statistical
associations like Jacobs et al.
Flossmann and Rothwell are certainly aware of Jacobs et al. results,
which were published before their study, but knowing these and their
own results they still recommend full-dose aspirin for people at high
risk of colorectal cancer, for example for blood-relatives of colon
cancer patients (if they can tolerate aspirin).
IMHO, where possible, regular colonoscopies could possibly be used
instead of aspirin for people at high risk of colorectal cancer.
Unfortunately in many countries this is not possible. Therefore I tend
to agree with Flossmann and Rothwell and suggest the daily use of
full-dose aspirin for people at high risk of colon cancer (at least
then, when regular colonoscopies are not possible), if they can
tolerate aspirin, and if their doctor agrees to it after assessing the
person's colorectal cancer risk and the possible risks the full-dose
aspirin could cause for her/him.
--
Matti Narkia
.
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