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The use of low dose aspirin in the elderly shows no effect in reducing the incidence of certain types of cancer. However, treatment – especially with a frequency of at least three times a week – is associated with reduced mortality in bladder cancer and breast cancer, according to new observational research.
“The results presented here add to the mounting evidence that aspirin may improve survival for some cancers,” write the authors in their cohort study that uses data from the prostate cancer screening trial, lung, colorectal and ovarian (PLCO). The new research was published online Jan.15 at JAMA network open.
“Although previous research has been more heavily focused on gastrointestinal cancers, our analysis extends the benefits associated with the use of aspirin to other cancers, such as bladder and breast cancers,” they explain.
Commenting on the study, John J. McNeil, MBBS, PhD, head of the Department of Epidemiology and Preventive Medicine at Monash University in Melbourne, Australia, said the results, while intriguing, were not necessarily conclusive.
“The data comes from a very large and well-conducted study,” said McNeil, who has led other research on aspirin use and the elderly. Medscape Medical News.
“But these conclusions were drawn from the observational component of the study and therefore potentially confused by other characteristics that differentiate aspirin users from non-users.”
Lack of research on aspirin / cancer in the elderly
With well-known reports of decreased risks of heart disease, stroke, cancer – especially gastrointestinal cancers – and all-cause mortality, up to 25% to 50% of adults in the United States report taking aspirin daily or every other day.
However, the evidence for cancer-related benefits, especially in the elderly, has been inconsistent, with a recent notable study, the double-blind randomized ASPREE trial, showing no effect of aspirin on cancer incidence. , but a higher death rate in the elderly. patients randomly assigned to aspirin for primary prevention.
To further study the effects in elderly patients, first author Holli A.
Loomans-Kropp, PhD, and colleagues at the National Cancer Institute evaluated data from patients 65 years of age or older at baseline or who had reached age 65 at follow-up to the PLCO Cancer Screening Trial, who had been recruited from 1993 to 2001..
The authors identified 139,896 individuals with a mean age at baseline of 66.4 years; about half were female and 88.5% were non-Hispanic whites.
Follow-up took place up to the time of death; December 2014 for those who consented to the follow-up; or December 2009 for those who refused to consent to follow-up. The authors report that there were 32,580 incident cancers, including 5.4% of the bladder, 14% of the breast, 1% of the esophagus, 1.2% of the stomach, 2.7% of the pancreas. and 2.2% of the uterus.
The study showed no association between aspirin use and the incidence of any of the types of cancer included in the study in people over 65 years of age.
However, further multivariate analysis of survival showed that, with adjusted follow-up to the time of death, December 31, 2015, or prior denial of consent, use of aspirin at least three times per week was associated with reduced mortality in bladder (risk ratio [HR], 0.67) and breast (HR, 0.75), while no significant association was observed with cancer of the esophagus, stomach, pancreas or uterus.
A similar association of any aspirin use (less than three times per week) with bladder (HR, 0.75) and breast cancer (HR, 0.79) survival was observed, the authors note.
“These results may indicate that for certain types of cancer any use of aspirin may be beneficial; however, a greater benefit may be seen with increased frequency of use,” write the authors.
Mechanism speculation focuses on COX-2 path
Theories of the mechanisms behind a potential benefit of aspirin for people with bladder cancer include that urothelial cancer increased expression of cyclooxygenase-2 (COX-2) RNA and proteins. and urinary prostaglandin E2, “suggesting upregulation of the COX-2 pathway during cancer progression,” the authors write.
In breast cancer, a similar elevated expression of COX-2 has been shown to predict disease outcomes, including progression and decreased survival.
“This may in part be due to the mechanistic interaction between angiogenesis, cell proliferation, apoptosis and inflammatory processes,” note the authors.
The study is not the first to show a benefit specifically with bladder cancer; Other studies include recent research showing that daily aspirin use in patients with bladder cancer was associated with increased 5-year survival after radical cystectomy, the authors note.
The Australian McNeil noted that the new findings by US researchers, especially regarding bladder cancer, are interesting. “The reduction in mortality from breast cancer is modest, but the reduction in mortality from bladder cancer has been more impressive,” he said.
“However, since this finding is observational data and was a single finding among multiple comparisons, it must be considered suggestive rather than proven.”
Regarding possible mechanisms, McNeil added that, like much of the previous research, many questions remain.
“There have been many suggestions as to how aspirin might work at the molecular and cellular level, but no firm consensus has been reached.”
The study authors and McNeil did not reveal any relevant financial relationships.
JAMA network open. Published on January 15, 2021. Full text
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