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Use of aspirin at specific doses appeared to be reduced for ovarian cancer and hepatocellular carcinoma.
Use of nonaspirin NSAIDs did not decrease the risk for HCC and appeared to increase the risk for ovarian cancer.
Studies have shown aspirin may reduce the risk for colorectal cancer. In 2015, the U.S. Preventive Services Task Force recommended aspirin to be considered for the prevention of colorectal cancer in patients aged 50 to 69 years with specific cardiovascular risk profiles.
However, questions remain about aspirin's effectiveness in preventing other types of cancer and regarding the appropriate dose and frequency for prevention. Evidence for cancer prevention has been mixed in the fields of ovarian cancer and HCC.
Ovarian cancer
prevention
Mollie
E.
Barnard, a postdoctoral fellow at the Huntsman Cancer Institute at The University of Utah, and colleagues used data from the Nurses' Health Study (n = 93,664; mean age at baseline, 45.9 years; 93% non-Hispanic white) – followed from 1980 to 2014 – and Nurses' Health Study II (n = 111,834; mean age at baseline, 34.2 years; 92% non-Hispanic white), followed from 1989 to 2015, to review the impact of anti-inflammatory drugs on ovarian cancer risk.
Aspirin – including low dose (100 mg) and standard dose (325 mg) – and nonaspirin NSAIDs. Researchers defined at least two doses per week.
Among the cohorts, researchers observed 1,054 cases of epithelial ovarian cancer.
Low-dose aspirin was consistently associated with a 23% lower risk for ovarian cancer (HR = 0.77; 95% CI, 0.61-0.96) compared with nonuse. However, aspirin use at the standard dose did not appear to decrease the risk for ovarian cancer (HR = 1.17, 95% CI, 0.92-1.49).
Researchers did not observe an association between ovarian cancer and aspirin use when aspirin was compared with nonuse (HR = 0.99, 95% CI, 0.83-1.19).
"What really differentiates this study from aspirin standard dose aspirin," Barnard said in a press release. "Our findings emphasize that research on aspirin use and cancer risk must consider aspirin dose. Our results also highlight the need for ongoing conversations between patients and their doctors on the risks and benefits of low-dose aspirin. "
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Current use of nonaspirin NSAIDs was associated with a 19% higher risk for ovarian cancer (HR = 1.19, 95% CI, 1-1.41) compared with nonuse. NSAID use (P for trend = .02) and cumulative average tablets per week (P for trend = .03).
"Our findings expand on two consortium studies showing that daily aspirin is related to lower ovarian cancer risk. Many people take a low-dose daily aspirin for heart disease prevention, " Shelley S. Tworoger, PhD, Associate Center Director of Population Science at Moffitt Cancer Center, said in the release. "More research is needed to figure out which women can benefit most from taking low-dose aspirin to reduce their risk of ovarian cancer."
Prevention
of
HCC
In a second study, Tracey G. Simon, MD, research fellow in medicine at Massachusetts General Hospital, and colleagues evaluated the impact of daily aspirin on HCC risk using data from Nurses' Health Study and the Health Professionals Follow-up Study.
The analysis included 87,507 women (mean age, 62 years) and 45,864 men (mean age, 64 years) with 4,232,188 person-years of follow-up.
Researchers observed 108 cases of HCC over more than 26 years.
Use of two or more 325 mg aspirin tablets per week with a reduced risk for HCC (HR = 0.51; 95% CI, 0.34-0.77). This association appeared to be dose related (P for trend = .006). In a multivariable analysis, HRs compared with nonuse were 0.87 (95% CI, 0.51-1.48) for 1.5 standard-dose tablets per week, 0.51 (95% CI, 0.3-0.86) for 1.5 to 5 tablets per week and 0.49 (95% CI, 0.3-0.86). % CI, 0.28-0.96) for more than 5 tablets per week.
Additional, increasing duration of use appears to lower HCC risk (P for trend = .03). Use of 1.5 or more standard-dose aspirin tablets per week for HCC (HR = 0.41; 95% CI, 0.21-0.77).
Nonaspirin NSAID use was not significantly associated with HCC risk (HR = 1.09, 95% CI, 0.78-1.51).
"The long duration of aspirin could be needed because of the growth of cancer. Aspirin may act at the earliest stages of cancer development, or even at precancerous stages, by delaying or preventing inflammation or liver fibrosis, "Simon said in a press release. "While it may be still too early, it may be an effective strategy to prevent HCC, efforts to understand the symptoms of these diseases.
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In an accompanying editorial, Victoria L. Seewaldt, MD, The Ruth Ziegler Professor, Chair of the Department of Population Sciences, and Associate Director for Population Science Research, City of Hope, Comprehensive Cancer Center, suggested areas for future research.
"The two studies …. have the power to start to change clinical practice; However, there is still much to be learned about the use of the mechanism and the use of aspirin, "she wrote. "Moreover, the conditions of caution, the potential benefits of aspirin must be weighed against the risk of bleeding, particularly in patients with chronic liver disease. To reach the full promise of aspirin 's ability to prevent cancer. by Cassie Homer
Disclosures: Barnard, Tworoger, Simon and Seewaldt report no relevant financial disclosures. One author of the study by Simon and colleagues reports a previous consultant role with Bayer.
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