Use of Aspirin Related to Reduced Risk of Liver and Ovarian Cancer

Two new studies examining different doses of aspirin in different cancers add to the growing evidence of the drug's beneficial role in reducing the risk of cancer.

Data from health studies of nurses showed that the risk of ovarian cancer was reduced by 23% in women taking aspirin regularly compared to non-aspirant women (HR 0.77, 95% CI 0.61-0.96), Mollie Barnard, ScD. Huntsman Cancer Institute at the University of Utah, and his colleagues reported.

And a 49% reduction in the risk of hepatocellular carcinoma (HCC) was observed in nurses and follow-ups of the health study of nurses and health professionals, with a history of use at home. long-term twice-weekly aspirin at regular dose (HR adjusted 0.51, 95% CI 0.34-0.77), according to Andrew T. Chan, MD, MPH, Massachusetts General Hospital, and colleagues .

Both sets of risk ratios reflected multivariate adjustment including factors such as age, menopausal status, parity, and family history of cancer.

The pair of studies, published in JAMA Oncology, come at a time when other discoveries are challenging the role of aspirin in the primary prevention of cardiovascular disease (CVD). In 2015, the US Prevention Services Working Group advocated the use of low-dose aspirin for the prevention of cardiovascular disease and colorectal cancer.

"This is the strongest evidence to date that using aspirin can reduce the risk of HCC," writes Victoria Seewaldt, MD of the City of Hope's Comprehensive Cancer Center in Duarte, Calif., In an editorial accompaniment.

Seewaldt said the two studies "have the power to start changing clinical practice," but cautioned that the benefit / risk ratio needs to be taken into account when recommending aspirin.

"The potential benefits of aspirin need to be weighed against the risk of bleeding, especially in people with chronic liver disease," said Seewaldt. "In order for aspirin to fully prevent cancer, we need to better understand the dose, duration and mechanism."

Low dose aspirin in ovarian cancer

"What really differentiated this study from previous work, that is, we were able to analyze low-dose aspirin separately from standard dose aspirin," he said. Barnard in a statement. "Our findings emphasize that research on the use of aspirin and the risk of cancer should take into account the dose of aspirin."

When the Barnard group examined the current use of aspirin at any dose compared to non-use, it found no association with the cancer risk of the drug. Ovary (HR 0.99, 95% CI 0.83-1.19). But the benefit of low dose aspirin was observed when they separated the aspirin dose (≤100 mg compared to 325 mg standard). No reduction in ovarian cancer risk was observed with regular aspirin (HR 1.17, 95% CI 0.92 to 1.49).

Investigators also found significant positive trends in favor of increasing cumulative weekly usage (P= 0.03 for the trend) and the duration of use of aspirin (P= 0.02 for the trend).

"These results suggest that the same low-dose, long-term aspirin-based regimens recommended for cardiovascular prophylaxis and reducing the risk of colorectal cancer may also reduce the risk of ovarian cancer," wrote Seewaldt in his editorial.

In contrast, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) without aspirin was related to an increased risk of ovarian cancer (HR 1.19, 95% CI 1.00-1, 41); no association was observed with the use of acetaminophen.

The study collected data on the use of NSAIDs and the diagnosis of ovarian cancer from the nurses' health study conducted between 1980 and 2014 (n = 93,664). ) and Nursing Health Study II (1989-2015) (n = 111,834). There were 1,054 cases of epithelial ovarian cancer in both studies.

Standard dose aspirin in CHC

"Regular use of aspirin resulted in a significant reduction in the risk of developing hepatocellular carcinoma compared with little or no use of aspirin, and we also found that risk decreased progressively with Aspirin dose increase and duration of use, "co-authored Tracey Simon, MD. Massachusetts General Hospital in Boston, said in a statement.

In comparison with the absence of aspirin, it appears that aspiration to reduce the risk of HCC has a dose-dependent advantage (P= 0.006 for the trend):

• ≤1.5 aspirin tablets at regular dose per week (adjusted HR: 0.87, 95% CI: 0.51 to 1.48)
• > 1.5 to 5 tablets per week (adjusted HR 0.51, 95% CI 0.30-0.86)
• > 5 tablets per week (adjusted HR 0.49, 95% CI 0.28-0.96)

The increase in the duration of use of aspirin (≥ 5 years) was significantly related to a lower risk of HCC (P= 0.03 for the trend), more particularly with ≥ 1.5 aspirin tablet at regular dose per week (adjusted HR 0.41, 95% CI 0.21-0.77).

"The long-term use of aspirin might be necessary because primary liver cancer takes several years to develop," Simon said. "Aspirin can act in the early stages of cancer development, even in precancerous stages, delaying or preventing inflammation or fibrosis of the liver."

The researchers found no association between the use of NSAIDs and the risk of HCC (adjusted HR 1.09, 95% CI 0.78-1.51).

"Given that the regular use of aspirin carries an increased risk of bleeding, the next step should be to study its impact on populations with established liver disease, as this group is already at risk of primary liver cancer, "said Simon.

Researchers conducted a pooled analysis of the Nurses' Health Study, which recruited more than 120,000 women aged 30 to 55 years. and the follow-up study of health professionals, which recruited more than 50,000 men aged 40 to 75 years. Both prospective studies were conducted in the United States.

Between the two studies, 133,371 people were included – those who provided data on their frequency, their dose and the duration of use of aspirin. There were 108 cases of HCC during the 26 years of follow-up.

2018-10-04T18: 30: 00-0400