Frequency-Risk and Duration-Risk Relationships between Aspirin Use and Gastric Cancer: A Systematic Review and Meta-Analysis

Abstract

BackgroundAlthough previous meta-analyses have suggested an association between aspirin use and risk of gastric cancer, current evidence is inconsistent. Additionally, it remains unclear whether there are frequency-risk and duration-risk relationships and if a threshold of effect exists.MethodsWe identified studies by searching MEDLINE and PUBMED databases and reviewing relevant articles. We derived the summary risk estimates using fixed-effects or random-effects model based on homogeneity analysis. The dose-response meta-analysis was performed by linear trend regression and restricted cubic spline regression. Potential heterogeneity was tested using the Q statistic and quantified with the I 2 statistic. Subgroup analyses and Galbraith plots were used to explore the potential sources of heterogeneity. Publication bias was evaluated with funnel plots and quantified by the Begg's and Egger's test.ResultsFifteen studies were included in this meta-analysis. There was an overall 29% reduced risk of gastric cancer corresponding to aspirin use (RR = 0.71, 95% CI 0.60–0.82). We found there are nonlinear frequency-risk and linear duration-risk relations between aspirin use and gastric cancer. A monotonically decreasing relation was observed only for low-frequency (≤4.5 times/week) aspirin intake (10% decreased risk for once/week, 19% for twice/week and 29% for 4.5 times/week), and the frequency threshold of aspirin use is 4.5 times per week. Regarding those with duration of aspirin use, there was a tendency towards stronger risk reduction of gastric cancer for longer aspirin use (10% decreased risk for 4 years, 19% for 8 years and 28% for 12 years), and no duration threshold was observed.ConclusionOur findings suggest that long-term (≥4 years) and low-frequency (1–4.5 times per week) aspirin use is associated with a statistically significant, dose-dependent reduction in the risk of gastric cancer.

General Aspects of Primary Cancer Prevention

“…However, this study did not observe the presence of a significant association between aspirin and breast, advanced prostate or lung cancer [55]. Another meta analysis showed an overall 29% reduced risk of gastric cancer corresponding to long-term aspirin use (≥4 years) [56]. Thus far, the use of prophylactic aspirin for a minimum of 5 years at doses between 75 and 325 mg appears to have a favorable benefit-harm profile, and might reduce the incidence of cancer by 7% in women and 9% in men (relative reduction dependent on age and sex).…”

The stomach in health and disease

“…Aspirin reduces the risk for oesophageal and gastric cancer by 30-40%. [166][167][168] To a lesser extent, other types of NSAIDs exert a similarly protective influence. [166][167][168] …”

European Code against Cancer 4th Edition: Medical exposures, including hormone therapy, and cancer

“…There is also substantial evidence to suggest that use of aspirin or non-aspirin NSAIDs may protect against upper gastrointestinal cancers, including oesophageal and gastric cancer [158,[169][170][171][172]. Metaanalyses of epidemiological studies have also indicated that NSAID use may protect against breast [158,[173][174][175], lung [158,176,177], endometrial [178], ovarian [179,180] and prostate [158,181,182] cancers, but the reported inverse associations of NSAID use with these cancers are weaker than those demonstrated for gastroenterological cancers.…”