Aspirin vs Cancer

It used to be pretty easy.  Take two aspirin and call me in the morning.  Then, everyone over a certain age was told to take aspirin.  There was even talk about putting it in the water.  However, after further analysis, it turned out that aspirin isn't actually as safe as we'd previously thought.  In large enough doses, it can actually increase your risk of stomach ulcers or bleeding in the brain (hemorrhagic stroke), neither of which are benign consequences.  Furthermore, the benefits aren't quite as clear cut.  It appears that aspirin protects men from heart attacks and women from (ischemic) strokes but not vice versa. 

In a study to be released tomorrow, authors analyzed the data from several larger studies involving over 25,000 patients randomized to varying doses of aspirin (75-500mg daily) vs placebo and followed for at least 4 years.  With a wave of the pencil and the punching of calculator keys, they concluded that aspirin was associated with a decrease risk of death from cancer.  The time required before one could expect benefit - at least 5 years.  The relative risk reduction varied depending upon the specific cancer but the good news is that the reduction in the cancer death rate was unrelated to sex, smoking & aspirin dose.  In other words, 75mg daily worked just as well as 500mg daily, but with less potential side effects.  More incredible, the older the patient, the greater the benefit!

Just last month, the same authors analyzed data from several previously published studies (involving over 14,000 patients followed for 18 years) and concluded that aspirin 75mg daily would reduce the risk of colorectal cancer and death from said cancer, especially that from the right (proximal) side, which are not found by sigmoidoscopy but only by colonoscopy assuming adequate preparation. 

So do we all need to start popping baby aspirin like candy?  Probably not yet.  Why? These are associative studies, not causative.  Yes, the data is compelling but it's not definitive.  However, if you're mature enough (read Medicare-age), have a strong Family History of cancer, are male with heart disease or female with stroke, then you probably should review these studies with your family physician and have a good discussion about your individual risks and benefits.  Unfortunately, this isn't going to be easy in the time typically allotted for a follow up visit.  But keep trying.  We really do want to listen to you!