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Two new studies have shown that regular long-term use of aspirin may reduce the risk of certain cancers, thus adding to the growing evidence that aspirin may play a role as an agent. chemo-prevention.
In the first study, a pooled analysis of two prospective US cohort studies showed that the use of aspirin was associated with a dose-dependent reduction in the risk of epoco-cellular cancer (HCC), an effect not observed with non-asteroidal anti-inflammatory drugs. (NSAID).
The second study analyzed the use of NSAIDs and the diagnosis of ovarian cancer using data from two large prospective cohorts and found that regular users of aspirin presented a lower risk of Ovarian cancer. Conversely, an increased risk of ovarian cancer has been observed during long-term use and in significant amounts of other analgesics, particularly NSAIDs without aspirin.
In an accompanying editorial, Victoria L. Seewaldt, MD, of the City of Hope Comprehensive Cancer Center, Duarte, Calif., States that both studies "have the power to begin to change clinical practice."
"Ovarian cancer and HCC are deadly cancers requiring new prevention strategies," she writes. "The results of these two studies provide important information that can guide chemoprevention."
Both articles and the editorial were published online on October 4 JAMA Oncology.
Find the connection
An increasing number of studies have attempted to unravel the relationship between the use of aspirin and its possible use for chemoprevention.
Last year, for example, a large observational study showed that regular use of aspirin was associated with both a reduced relative risk of all-cause death and cancer.
Also in 2017, a study showed that regular use of NSAIDs in long-term survivors of colorectal cancer was significantly associated with an improvement in overall survival, although this benefit has been limited to patients with colorectal cancer. KRAS wild-type tumors.
A third recent study also found that regular use of aspirin was associated with a 46% reduction in the relative risk of pancreatic cancer.
"Several decades of research provide strong evidence that the anti-inflammatory properties of aspirin can reduce the risk of cancer, particularly for colorectal cancer," writes Seewaldt in his editorial. "In 2015, given the strength of the link between the use of aspirin and the reduction of colorectal cancer risk, the US Task Force on Preventive Services (USPSTF) recommended that the use of aspirin be used to reduce the risk of colorectal cancer. include the prevention of colorectal cancer in people aged 50 to 69 years with specific cardiovascular risk profiles, the rationale for regular aspirin prophylaxis ".
However, she pointed out that despite the recommendations of the USPSTF, many questions remained unanswered regarding the use of aspirin as a way to reduce the risk of colorectal cancer. These include the dose and timing of chemoprevention of aspirin and the molecular mechanisms underlying the effects of chemoprevention of aspirin.
Seewaldt says the most important unanswered question is "the ability of aspirin to prevent other malignancies".
The results of these two new studies can help answer this last question. The articles provide "key evidence that supports the ability of regular use of aspirin to prevent ovarian cancer and HCC, respectively," she says. "The results of these two studies provide important information that can guide chemoprevention."
Reduce the risk of HCC
In the first study, Tracey G. Simon, Massachusetts General Hospital, Boston, and colleagues evaluated the potential benefits of using aspirin for primary prevention of HCC using the data from the health of nurses and health professionals. , with a total cohort of 133,371 health professionals (87,507 women and 45,864 men). Regular use has been defined as a standard dose (325 mg) of aspirin tablet taken at least twice or more per week.
After more than 26 years of follow-up, the authors found that regular use of aspirin was associated with a significant 49% reduction in the risk of developing HCC.
The incidence rate of CHC among regular users of aspirin was 2.1 cases / 100,000 person-years, whereas it was 5.2 cases / 100,000 person-years for non-users (P <0.001). This benefit seemed to depend on both dose and duration and was evident with the use of aspirin for 5 years or longer, at a dose of 1.5 or more standard tablets per week.
Adjustment for regular non-aspirin NSAID use (≥2 tablets / week) had no effect on the results, and the benefit of aspirin over HCC was consistent across all predefined groups (all P > 0.05).
With respect to non-aspirin NSAIDs, a reduction in the risk of HCC was not observed with regular use compared to non-regular use, and there was no evidence of Association between the increasing duration of use of NSAIDs and the risk of HCC (HR for use ≥ 10 years compared to non-use, 1.06; P for linear trend = 0.20 among users).
"Our findings add to the growing literature suggesting that the chemopreventive effects of aspirin could extend beyond colorectal cancer," the authors conclude.
Reduced risk of ovarian cancer
The second study evaluated whether regular use of aspirin or non-aspirin by NSAIDs could reduce the risk of ovarian cancer. Under the direction of Mollie E. Barnard, ScD, of the Chan School of Public Health at Harvard University in Boston, Massachusetts, the authors evaluated the use of aspirin or non-aspirin. Aspirin with a risk of ovarian cancer.
Their data came from two potential cohorts: 93,664 women in the nurses 'health study were followed from 1980 to 2014 and 111,834 women in the Nurses' Health Study II from 1989 to 2015.
The time, duration, frequency and number of tablets used were evaluated for each type of analgesic (aspirin, low-dose aspirin, non-aspirin NSAID and acetaminophen) and the data were updated every 2 at 4 years old. A total of 1054 cases of incident epithelial ovarian cancer occurred in the combined total cohort.
No significant association was observed between the use of aspirin and the risk of ovarian cancer when comparing current and non-consumer users, irrespective of the administered dose (HR: 0.99, 95% CI: 0.83 – 1.19). However, when the authors assessed the low and standard doses separately, there was an inverse association for low-dose aspirin (HR, 0.77, 95% CI, 0.61-0.96), but none for standard dose aspirin (HR, 1.17, 95% CI, 0.92 – 1.49).
Overall, this risk has been extrapolated to a risk of ovarian cancer reduced by 23% among current users of low dose aspirin compared to non-users.
A long-term association with standard dose aspirin (≥ 5 years vs <1 year) was positive (HR, 1.77, 95% CI, 1.13 – 2.77; P = 0.004 for trend) and for 2500 tablets / day or more of standard dose aspirin, compared to normal use (HR, 1.58, 95% CI, 1.00 to 2.48; P = 0.02 for the trend).
In contrast, the current use of non-aspirin NSAIDs has been positively associated with an increased risk of ovarian cancer compared to non-use (HR, 1.19, 95% CI, 1%). , 00 – 1.41), with significant positive trends for the duration of use (P = 0.02 for the trend) and average cumulative tablets per week (P = 0.03 for the trend).
These data resulted in a relative risk of ovarian cancer greater than 19% among regular NSAID use compared to non-users.
The HCC study was funded by grants from the Nurses' Health Study, the Follow-up Study of Health Professionals and the National Institutes of Health. The study on ovarian cancer was funded by the National Institutes of Health. A co-author of the HCC study previously served as a consultant for Bayer Pharma AG on work unrelated to the study. No other disclosures have been reported. Seewaldt is supported by grants from the National Cancer Institute and the Prevent Cancer Foundation.
JAMA Oncol. Posted online 4 October 2018. Study 1, Study 2, Editorial
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