Alternate-Day, Low-Dose Aspirin and Cancer Risk: Long-Term Observational Follow-up of a Randomized Trial

Annals of internal medicine (Impact Factor: 17.81). 07/2013; 159(2):77-85. DOI: 10.7326/0003-4819-159-2-201307160-00002
Source: PubMed


Chinese translation
Recent evidence suggests that daily aspirin use decreases cancer risk, particularly for colorectal cancer, but evidence for alternate-day use is scant.
To examine the association between long-term, alternate-day, low-dose aspirin and cancer in healthy women.
Observational follow-up of a randomized trial.
Female health professionals.
39 876 women aged 45 years or older in the Women's Health Study ( NCT00000479), 33 682 of whom continued observational follow-up.
100 mg of alternate-day aspirin or placebo through March 2004, with a median 10-year follow-up. Posttrial follow-up continued through March 2012.
Cancer incidence.
A total of 5071 cancer cases (including 2070 breast, 451 colorectal, and 431 lung cancer cases) and 1391 cancer deaths were confirmed. Over the entire follow-up, aspirin had no association with total (hazard ratio [HR], 0.97 [95% CI, 0.92 to 1.03]; P = 0.31), breast (HR, 0.98 [CI, 0.90 to 1.07]; P = 0.65), or lung (HR, 1.04 [CI, 0.86 to 1.26]; P = 0.67) cancer. Colorectal cancer was reduced in the aspirin group (HR, 0.80 [CI, 0.67 to 0.97]; P = 0.021), primarily for proximal colon cancer (HR, 0.73 [CI, 0.55 to 0.95]; P = 0.022). The difference emerged after 10 years, with a posttrial reduction of 42% (HR, 0.58 [CI, 0.42 to 0.80]; P < 0.001). There was no extended effect on cancer deaths or colorectal polyps. More gastrointestinal bleeding (HR, 1.14 [CI, 1.06 to 1.22]; P < 0.001) and peptic ulcers (HR, 1.17 [CI, 1.09 to 1.27]; P < 0.001) occurred in the aspirin group.
Not all women received extended follow-up, and posttrial ascertainment bias cannot be ruled out. Gastrointestinal bleeding, peptic ulcers, and polyps were self-reported during extended follow-up.
Long-term use of alternate-day, low-dose aspirin may reduce risk for colorectal cancer in healthy women.
National Institutes of Health.

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    • "The strongest evidence for the use of aspirin in cancer prevention thus far lies in the data concerning aspirin's potential protective effects against colon cancer. Regular use of adult-strength (375 mg) aspirin was associated with a 20% statistically significant reduced risk of colorectal cancer [9], and taking low-dose aspirin every other day also appears to have a lesser protective effect against colon cancer [10]. However, the use of low-dose aspirin following the diagnosis of colorectal cancer does not improve the overall survival rate [11]. "
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