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Aspirin Controversies

Posted 4/28/2015

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  I have written before about the potential benefit of aspirin in reducing the recurrence rate for breast cancer (and, presumably, other cancers, too). Any such recommendations also come with the "Talk with your doctor"  caveat as everyone is different and aspirin can have some downsides. However, this is a unique moment with the publication of two opposing views. One, not directed specifically at cancer patients, suggests that too many Americans take a daily aspirin in spite of the potential risks being greater than the potential individual benefit. The other reinforces the possible positive impact of a daily aspirin on breast cancer recurrence.

  First, as reported on NPR, is a study from The American Journal of Preventive Medicine, stating that more than 50% of Americans between the ages of 45 and 75 take a daily aspirin , and that 47% of those Americans have never had a heart attack or a stroke. Now, we know that this report is not looking an people with a cancer history, but is thinking about the primary prescribed value of aspirin which is to prevent blood clots and reduce the incidence of heart attacks and strokes. Here is the start and then a link to read this precautionary tale:

Maybe You Should Rethink That Daily Aspirin

We've all heard that an aspirin a day can keep heart disease at bay. But lots of
Americans seem to be taking it as a preventive measure, when many probably
shouldn't.
In a recent national survey, more than half the adults who were middle age or older
reported taking an aspirin regularly to prevent a heart attack or stroke. The Food and
Drug Administration only recommends the drug for people who've already
experienced such an event, or who are at extremely high risk.

The survey, published in the American Journal of Preventive Medicine, found that 52
percent of people age 45 to 75 are taking aspirin daily or every other day. And 47
percent are taking it even though they have never had a heart attack or stroke.
"That's very controversial in the medical community," says Craig Williams, a
pharmacologist at Oregon State University,who led the study.

Read more: http://www.npr.org/blogs/health/2015/04/27/402039544/maybe-you-should-rethink-that-daily-aspirin

Now, here is where it starts to get tricky for us. Just because we have had cancer does not mean that we are protected from other kinds of health problems. Indeed, since many of us are hoping to live to ripe and healthy old ages, we likely will have to contend with other things that accompany those accumulating years. What goes to the top of our worry lists? Cancer? Or heart disease or stroke or diabetes or....? The answer is probably different for each of us, but cancer may move further down the worry list as time passes.

This second study is from the Journal of Cancer Causes Control. It suggests the very real value of daily aspirin for women who have had breast cancer (and who, presumably, have discussed this with their doctors). Here is the abstract. If you want to read the whole article, email me (hhill@bidmc.harvard.edu), and I will send it along to you.

Aspirin and nonsteroidal anti-inflammatory drugs
after but not before diagnosis are associated with improved breast
cancer survival: a meta-analysis

Abstract
Purpose The association between nonsteroidal antiinflammatory
drugs (NSAIDs) and breast cancer survival is
still controversial. The aim of our meta-analysis was to
assess the survival benefit of NSAIDs.
Methods A literature search was conducted in PubMed
and EMBASE (to September 2014). A meta-analysis was
performed with hazard ratios (HRs) and 95 % confidence
intervals (CIs) as the effect measures. Subgroup analyses
were based on time of NSAID use (before and after diagnosis),
medication type (aspirin and other nonaspirin
NSAIDs), and study design (cohort and case–control
studies).
Results There were 16 eligible studies. Use of NSAIDs
after diagnosis was significantly inversely associated with
relapse/metastasis (HR 0.69, 95 % CI 0.59–0.80) and tended
toward potentially protective effects on all-cause
mortality, although significance was not reached (HR 0.79,
95 % CI 0.61–1.02). In cohort studies, the association
between post-diagnostic use of NSAIDs and breast cancer
survival was stronger with reduced heterogeneity (breastcancer-
specific mortality: HR 0.65, 95 % CI 0.48–0.89,I2 = 65.3 %; all-cause mortality: HR 0.73, 95 % CI
0.57–0.92, I2 = 83.2 %; relapse/metastasis: HR 0.73, 95 %
CI 0.61–0.86, I2 = 48.3 %). Aspirin use after diagnosis
was significantly associated with breast-cancer-specific
mortality (HR 0.69, 95 % CI 0.50–0.96) and relapse/
metastasis (HR 0.75, 95 % CI 0.56–1.00), and tended toward
a protective effect on all-cause mortality, although
significance was not reached (HR 0.79, 95 % CI
0.60–1.03). Including cohort studies only, we obtained
similar results and post-diagnostic use of aspirin was significantly
associated with all-cause mortality (HR 0.72,
95 % CI 0.56–0.93).
Conclusions NSAIDs and aspirin after but not before
diagnosis were associated with improved breast cancer
survival, including breast-cancer-specific mortality, all cause
mortality, and relapse/metastasis.

 


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