Aspirin for the Prevention of Cancer Incidence and Mortality: Systematic Evidence Reviews for the U.S. Preventive Services Task Force

Chubak, Jessica; Whitlock, Evelyn P; Williams, Selvi B; Kamineni, Aruna; Burda, Brittany U; Buist, Diana S.M.; Anderson, Melissa L.

doi:10.7326/m15-2117

Cited by 175 publications

(179 citation statements)

References 67 publications

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“…7 However, in their 2015 updated draft recommendations, the USPSTF reversed this position, acknowledging that supporting evidence had become compelling enough 8,9 to warrant the inclusion of CRC prevention into their rationale for routine low-dose aspirin use among certain subgroups of adults with specific cardiovascular risk profiles. 10 This recommendation distinguishes aspirin as the first pharmacologic agent to be endorsed by the USPSTF for chemoprevention of a cancer in a population not characterized as high risk.…”

Section: Introductionmentioning

confidence: 99%

Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer

et al. 2016

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Importance The U.S. Preventive Services Task Force recently recommended the use of aspirin to prevent colorectal cancer and cardiovascular disease among many U.S adults. However, the association of aspirin on risk of other cancer types, and aspirin’s potential population-wide impact on cancer, particularly within the context of screening, remain uncertain. Objective To examine potential benefits of aspirin use for overall and subtype-specific cancer prevention, at a range of doses and duration of use, and estimate the absolute benefit of aspirin in the context of screening. Design Two large prospective cohort studies: the Nurses’ Health Study (NHS, 1980–2010) and Health Professionals Follow-up Study (HPFS, 1986–2012). Setting Health professionals in the United States Participants 88,084 women and 47,881 men participating in the NHS and HPFS who reported aspirin use biennially. Main Outcome Measures Relative risks (RRs) for incident cancers and population attributable risk (PAR). Results During up to 32 years of follow-up, we documented 20,414 cancers among women and 7,571 among men. Compared with nonregular use, regular aspirin use was associated with lower risk of overall cancer (RR 0.97; 95% CI 0.94, 0.99), which was primarily due to a lower incidence of gastrointestinal cancers (RR 0.85; 95% CI 0.80, 0.91), especially colorectal cancers (RR 0.81; 95% CI 0.75, 0.88). The benefit of aspirin on gastrointestinal cancers appeared evident with use of at least 0.5 to 1.5 standard aspirin tablets per week; the minimum duration of regular use associated with lower risk was 6 years. Among individuals aged over 50, regular aspirin use could prevent 33 colorectal cancers (PAR 17.0%) among those who have not undergone a lower endoscopy and 18 colorectal cancers per 100,000 person-years (PAR 8.5%) among those who have. Regular aspirin use was not associated with risk of breast, advanced prostate, or lung cancer. Conclusions and Relevance Long-term aspirin use was associated with modest but significantly reduced risk of overall cancer, especially gastrointestinal tumors. Regular aspirin use may prevent a substantial proportion of colorectal cancers and complement the benefits of screening.

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Section: Introductionmentioning

confidence: 99%

Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer

et al. 2016

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“…15 The lower potential net health benefit from aspirin counseling in our analysis is largely a result of the substantially narrowed target population for the service in the current recommendation and the changes to the underlying evidence of aspirin's benefits and harms, including lower expected effectiveness in preventing nonfatal myocardial infarction and stroke-which no longer differ by sex-and accounting for fatalities from aspirin-induced bleeding. 27,32,82,83 This study contributes to a broader evidence base that uses modeling to assess the incremental and comparative effectiveness of clinical services for the primary prevention of CVD. Direct comparisons are often difficult because of differing research questions and methods.…”

Section: Discussionmentioning

confidence: 99%

Health Benefits and Cost-Effectiveness of Asymptomatic Screening for Hypertension and High Cholesterol and Aspirin Counseling for Primary Prevention

et al. 2017

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“…Though the included studies mainly examined clopidogrel, DAPT examined clopidogrel and prasugrel and has not published the dichotomised data to date. The use of aspirin in the comparison group in early trials could affect the results for clopidogrel, but the direction of this effect would likely lead to an overshooting of the odds ratio as several studies suggest that aspirin reduces cancer event rate and mortality (32)(33)(34). Indeed, later trials (CHARISMA, DAPT, TRILOGY) have included aspirin in both groups, but the influence of this addition on cancer event rate or mortality is unexplored (12,13,21).…”

Section: Discussionmentioning

confidence: 99%

Cancer Event Rate and Mortality with Thienopyridines: A Systematic Review and Meta-Analysis

et al. 2016

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Introduction: Thienopyridines are a class of antiplatelet drugs widely used in cardiovascular disease prevention and treatment. There is recent concern regarding the safety of thienopyridines because of possible malignancy risk. Therefore, we performed a systematic review and meta-analysis to evaluate the association between thienopyridine exposure and malignancy. Methods:We searched MEDLINE and EMBASE in March 2016 for studies which evaluated incident cancer and cancer mortality with and without exposure to thienopyridines. Relevant studies were identified, data were extracted and analysed with random effects meta-analysis.Results: A total of 9 studies (6 randomised controlled trials and 3 cohort studies) with 311,595 participants were included. The cancer event rate during the study period with clopidogrel and prasugrel was 1.56%. When compared to standard aspirin or placebo, thienopyridines are not significantly associated with cancer mortality and event rate OR 1.12 [95% CI 0.80-1.56, n=3] and OR 0.92 [95% CI 0.52-1. 64, n=2] respectively. Further analyses examining clopidogrel only showed no significant association with cancer event rate or malignancy related death. When comparing prasugrel to clopidogrel no significant association was noted for cancer event rate OR 1.10 [95% CI 0.89-1.37, n=2]. Subanalyses according to cancer location showed that thienopyridines are not significantly associated with malignancy mortality and/or incidence. Conclusions:Our results suggest that there is currently insufficient evidence to suggest that thienopyridine exposure is associated with an increased risk of cancer event rate or mortality. 3 Key points:• Cancer-related mortality is not linked to thienopyridines with contemporary data• Standardisation of cancer-end points in trials will reduce adjudication bias• Cohort studies can be used to supplement trial findings due to longer follow-up 4

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Aspirin for the Prevention of Cancer Incidence and Mortality: Systematic Evidence Reviews for the U.S. Preventive Services Task Force

Abstract: Agency for Healthcare Research and Quality.

Cited by 175 publications

References 67 publications

Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer

Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer

Health Benefits and Cost-Effectiveness of Asymptomatic Screening for Hypertension and High Cholesterol and Aspirin Counseling for Primary Prevention

Cancer Event Rate and Mortality with Thienopyridines: A Systematic Review and Meta-Analysis

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