Review

. 2015 Jan;26(1):47-57.

doi: 10.1093/annonc/mdu225. Epub 2014 Aug 5.

Estimates of benefits and harms of prophylactic use of aspirin in the general population

J Cuzick¹, M A Thorat², C Bosetti³, P H Brown⁴, J Burn⁵, N R Cook⁶, L G Ford⁷, E J Jacobs⁸, J A Jankowski⁹, C La Vecchia¹⁰, M Law¹¹, F Meyskens¹², P M Rothwell¹³, H J Senn¹⁴, A Umar¹⁵

Affiliations

¹ Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK. Electronic address: j.cuzick@qmul.ac.uk.
² Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
³ Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.
⁴ Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, USA.
⁵ Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.
⁶ Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston.
⁷ Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda.
⁸ Epidemiology Research Program, American Cancer Society, Atlanta, USA.
⁹ Centre for Biomedical Research-Translational and Stratified Medicine, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth; Centre for Digestive Diseases, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, UK.
¹⁰ Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
¹¹ Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
¹² Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, USA.
¹³ Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.
¹⁴ Tumor and Breast Center ZeTuP, St Gallen, Switzerland.
¹⁵ Gastrointestinal and Other Cancers Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, USA.

PMID: 25096604
PMCID: PMC4269341
DOI: 10.1093/annonc/mdu225

Review

Estimates of benefits and harms of prophylactic use of aspirin in the general population

J Cuzick et al. Ann Oncol. 2015 Jan.

. 2015 Jan;26(1):47-57.

doi: 10.1093/annonc/mdu225. Epub 2014 Aug 5.

Authors

Affiliations

¹ Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK. Electronic address: j.cuzick@qmul.ac.uk.
² Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
³ Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.
⁴ Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, USA.
⁵ Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.
⁶ Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston.
⁷ Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda.
⁸ Epidemiology Research Program, American Cancer Society, Atlanta, USA.
⁹ Centre for Biomedical Research-Translational and Stratified Medicine, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth; Centre for Digestive Diseases, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, UK.
¹⁰ Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
¹¹ Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
¹² Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, USA.
¹³ Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.
¹⁴ Tumor and Breast Center ZeTuP, St Gallen, Switzerland.
¹⁵ Gastrointestinal and Other Cancers Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, USA.

PMID: 25096604
PMCID: PMC4269341
DOI: 10.1093/annonc/mdu225

Abstract

Background: Accumulating evidence supports an effect of aspirin in reducing overall cancer incidence and mortality in the general population. We reviewed current data and assessed the benefits and harms of prophylactic use of aspirin in the general population.

Methods: The effect of aspirin for site-specific cancer incidence and mortality, cardiovascular events was collated from the most recent systematic reviews. Studies identified through systematic Medline search provided data regarding harmful effects of aspirin and baseline rates of harms like gastrointestinal bleeding and peptic ulcer.

Results: The effects of aspirin on cancer are not apparent until at least 3 years after the start of use, and some benefits are sustained for several years after cessation in long-term users. No differences between low and standard doses of aspirin are observed, but there were no direct comparisons. Higher doses do not appear to confer additional benefit but increase toxicities. Excess bleeding is the most important harm associated with aspirin use, and its risk and fatality rate increases with age. For average-risk individuals aged 50-65 years taking aspirin for 10 years, there would be a relative reduction of between 7% (women) and 9% (men) in the number of cancer, myocardial infarction or stroke events over a 15-year period and an overall 4% relative reduction in all deaths over a 20-year period.

Conclusions: Prophylactic aspirin use for a minimum of 5 years at doses between 75 and 325 mg/day appears to have favourable benefit-harm profile; longer use is likely to have greater benefits. Further research is needed to determine the optimum dose and duration of use, to identify individuals at increased risk of bleeding, and to test effectiveness of Helicobacter pylori screening-eradication before starting aspirin prophylaxis.

Keywords: aspirin; benefit-harm; cancer; cardiovascular disease; gastrointestinal bleeding; prevention.

PubMed Disclaimer

Figures

**Figure 1.**
Cumulative effects of aspirin taken for 10 years starting at 55 years of age: on deaths over next 20 years in 100 average-risk men (A) and women (B).

See this image and copyright information in PMC

Comment in

Daily aspirin reduces risk of developing and dying from cancer, researchers find.
Torjesen I. Torjesen I. BMJ. 2014 Aug 5;349:g5037. doi: 10.1136/bmj.g5037. BMJ. 2014. PMID: 25098322 No abstract available.
Reply to the letter to the editor 'the harms of low-dose aspirin prophylaxis are overstated' by P. Elwood and G. Morgan.
Thorat MA, Cuzick J. Thorat MA, et al. Ann Oncol. 2015 Feb;26(2):442-3. doi: 10.1093/annonc/mdu546. Epub 2014 Nov 17. Ann Oncol. 2015. PMID: 25403580 No abstract available.
The harms of low-dose aspirin prophylaxis are overstated.
Elwood P, Morgan G. Elwood P, et al. Ann Oncol. 2015 Feb;26(2):441-2. doi: 10.1093/annonc/mdu538. Epub 2014 Nov 21. Ann Oncol. 2015. PMID: 25416686 No abstract available.

References

1. Baigent C, Blackwell L, Collins R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373:1849–1860. - PMC - PubMed
1. Rothwell PM, Fowkes FG, Belch JF, et al. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet. 2011;377:31–41. - PubMed
1. Rothwell PM, Price JF, Fowkes FG, et al. Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. Lancet. 2012;379:1602–1612. - PubMed
1. Rothwell PM, Wilson M, Elwin CE, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. Lancet. 2010;376:1741–1750. - PubMed
1. Rothwell PM, Wilson M, Price JF, et al. Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials. Lancet. 2012;379:1591–1601. - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
Other Literature Sources
- H1 Connect - Access expert opinions and insights on biomedical research.
- scite Smart Citations
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Estimates of benefits and harms of prophylactic use of aspirin in the general population

Affiliations

Estimates of benefits and harms of prophylactic use of aspirin in the general population

Authors

Affiliations

Abstract

Figures

Comment in

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical