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Reduction in risk of colon cancer in people who took 600 mg of aspirin daily for at least two years, compared with those who took placebo. The randomized trial, published in The Lancet, focused on patients with Lynch syndrome, a rare genetic condition that predisposes people to colorectal and other cancers, so the findings don't easily translate to the general public. [via MedPage Today]
LONDON | Fri Oct 28, 2011 2:32am EDT
LONDON (Reuters) - Taking two aspirin a day for two years reduces the long-term risk of bowel cancer in people with a family history of the disease by around 60 percent, according to a British study published Friday.
The finding could also have implications for the wider population, though more research is needed to determine an ideal dose for different groups of people.
In recent years there has been an intense debate about the merits of routinely taking aspirin, which increases the risk of stomach ulcers and internal bleeding, but also protects against heart problems.
John Burn of Newcastle University believes his study -- the first randomized controlled trial into the effect of aspirin on cancer outcomes -- is a key piece of evidence validating the case for aspirin.
Previous research into cancer and aspirin, a cheap drug originally developed by Bayer more than a century ago, has been based on less robust observational studies.
Burn's study looked at people with Lynch syndrome, a genetic condition predisposing them to a range of cancers. It affects at least one in 1,000 people and around half of them develop cancer, mainly in the bowel and womb.
His data suggests that for every 10,000 cancers prevented, there could be 1,000 extra ulcers due to aspirin.
"There's a trade-off. If we could get by on a smaller dose, then we could potentially avoid a lot of those ulcers," Burn told a news conference.
For the general population, taking low-dose aspirin might be a more sensible option, and a major new multi-dose trial should shed more light on this in the next few years, he added.
DELAYED EFFECT
Burn and colleagues studied 861 people with Lynch syndrome, who began a two-year course of either 600 milligrams a day of aspirin or a placebo between 1999 and 2005.
An initial analysis in 2007 found no difference in cancer rates between the groups. But it turned out the effect was delayed and in 2010 there was a clear divergence, with 19 new bowel cancers among those on aspirin and 34 in the placebo arm.
What is more, among those patients who stuck to the full two-year regimen of pill-taking -- some 60 percent of the total -- the effects were more pronounced, and strongly statistically significant, with a 63 percent reduction in bowel cancer cases from 23 in the placebo group versus 10 in the aspirin group.
"What we have finally shown is that aspirin has a major preventative effect on cancer but this doesn't become apparent until years later," Burn said.
How exactly aspirin provides protection is unclear, but Burn said the delayed effect suggested aspirin may hit faulty stem cells before they mutate into pre-cancerous cells.
The study, which was published online by the Lancet medical journal and part-funded by Bayer, also found some evidence of a reduction in other solid cancers linked to Lynch syndrome.
"This is a really important study showing that aspirin can significantly reduce the risk of bowel and other cancers in patients genetically at high risk of developing cancer," said Chris Paraskeva of the University of Bristol, who was not involved in the research.
In a commentary in the Lancet, Andrew Chan of Harvard Medical and Scott Lippman of the MD Anderson Cancer Center in Houston said the findings were "compelling" and arguably supported more general recommendations to consider aspirin for preventing bowel cancer, based on individual patients' risks.
(Reporting by Ben Hirschler; Editing by Will Waterman)
Does and aspirin a day keep the cancer surgeon away? A daily dose of aspirin should be given to people at high risk of bowel cancer, say scientists. Two pills a day for two years reduced the incidence of bowel cancer by 63% in a group of 861 at-risk patients, a study reported in The Lancet said.
Newcastle University's Prof Sir John Burn, who led the study, said the evidence "seems overwhelmingly strong".
Other experts said the findings added to a growing body of proof that aspirin could be used in the fight on cancer.
The study was conducted on 861 patients with Lynch syndrome, which affects one in every 1,000 people.
They struggle to detect and repair damaged DNA which means they are more likely to develop a range of cancers including those of the bowel, womb and stomach.
'Good deal'When looking at all patients in the trial, those in the group given 600 milligrams of aspirin every day developed 19 tumours compared to 34 tumours in the other "control" group, a reduction of 44%.
Continue reading the main storyPeople who've got a clear family history of, particularly, bowel cancer should seriously consider adding low dose aspirin to their routine and particularly those people who've got a genetic predisposition”End Quote Prof Sir John Burn Newcastle University When the researchers looked at just those patients who took the medication for at least two years the reduction was 63%.
There was also an effect on other cancers linked to Lynch syndrome, which fell by half in the treatment group.
Prof Sir John Burn, from Newcastle University, said there were 30,000 adults in the UK with Lynch syndrome.
If all were given the treatment he said it would prevent 10,000 cancers over 30 years and he speculated that this could possibly prevent 1,000 deaths from the disease.
However, there would also be side effects.
"If we can prevent 10,000 cancers in return for 1,000 ulcers and 100 strokes, in most people's minds that's a good deal," he said.
"People who've got a clear family history of, particularly, bowel cancer should seriously consider adding low dose aspirin to their routine and particularly those people who've got a genetic predisposition."
Aspirin is already well known to reduce the risk of heart attack and stroke in high risk patients.
Continue reading the main story
Audrey Francis describes herself as "a bit of a walking time bomb".
There is a history of cancer in her family and she has been diagnosed with Lynch syndrome.
Seventeen years ago she had a hysterectomy. That was when doctors discovered she had not one but two cancers - in the womb and the ovaries.
Tests showed she had a chunk of DNA missing which was causing the cancers: "I actually had the inability to stop the cancers developing," she said.
She took part in the trial and has since decided to self medicate with aspirin: "I've got my fingers crossed and I'm hoping it'll do the trick for me."
Other studies over the past two decades have suggested the pain killer reduced cancer risk, but this was the first randomised control trial, specifically for aspirin in cancer, to prove it.In 2010, a study suggested patients given aspirin had a 25% lower risk of death during that trial.
Prof Peter Rothwell, from Oxford University, who conducted that study said the latest research "certainly helps to build a consistent picture, all pointing in the same direction that there is a link with cancer".
Cancer Research UK's Prof Chris Paraskeva said: "This adds to the growing body of evidence showing the importance of aspirin, and aspirin-like drugs, in the fight against cancer."
'Balanced argument'One of the questions asked by the research into aspirin was whether healthy people with no family risks should take the drug.
The lower the risk of heart attack or cancer, the lower the benefit of taking aspirin, yet there are still potentially deadly side effects.
Sir John said that it was a "finely balanced argument" and that he decided the risks were worth it for him.
"I think where we're headed for is people that are in their 50s and 60s would look very seriously at adding a low dose aspirin to their daily routine because it's giving protection against cancer, heart attack and stroke.
"But if they do that they've got to have their eyes wide open. They will increase their risk of ulcers and gastrointestinal bleeds and very rarely they will have a stroke caused by the aspirin."
