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

J. Cuzick, M.A. Thorat, C. Bosetti, P.H. Brown, J. Burn, N.R. Cook, L.G. Ford, E.J. Jacobs, Janusz jankowski, C. La Vecchia, M. Law, F. Meyskens, P.M. Rothwell, H.J. Senn, A. Umar

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    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.
    Original languageEnglish
    Pages (from-to)47-57
    JournalAnnals of Oncology
    Volume26
    Issue number1
    DOIs
    Publication statusPublished - 2014

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    Aspirin
    Population
    Hemorrhage
    Neoplasms
    Mortality
    Incidence
    Peptic Ulcer
    Helicobacter pylori
    Stroke
    Myocardial Infarction
    Research

    Bibliographical note

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

    International Society of Cancer Prevention (ISCaP), Cancer Research UK (CRUK), British Heart Foundation (BHF) and American Cancer Society (ACS) and received funding from CRUK, BHF and ACS

    Cite this

    Cuzick, J., Thorat, M. A., Bosetti, C., Brown, P. H., Burn, J., Cook, N. R., ... Umar, A. (2014). Estimates of benefits and harms of prophylactic use of aspirin in the general population. Annals of Oncology, 26(1), 47-57. https://doi.org/10.1093/annonc/mdu225

    Estimates of benefits and harms of prophylactic use of aspirin in the general population. / Cuzick, J.; Thorat, M.A.; Bosetti, C.; Brown, P.H.; Burn, J.; Cook, N.R.; Ford, L.G.; Jacobs, E.J.; jankowski, Janusz; La Vecchia, C.; Law, M.; Meyskens, F.; Rothwell, P.M.; Senn, H.J.; Umar, A.

    In: Annals of Oncology, Vol. 26, No. 1, 2014, p. 47-57.

    Research output: Contribution to journalArticle

    Cuzick, J, Thorat, MA, Bosetti, C, Brown, PH, Burn, J, Cook, NR, Ford, LG, Jacobs, EJ, jankowski, J, La Vecchia, C, Law, M, Meyskens, F, Rothwell, PM, Senn, HJ & Umar, A 2014, 'Estimates of benefits and harms of prophylactic use of aspirin in the general population' Annals of Oncology, vol. 26, no. 1, pp. 47-57. https://doi.org/10.1093/annonc/mdu225
    Cuzick, J. ; Thorat, M.A. ; Bosetti, C. ; Brown, P.H. ; Burn, J. ; Cook, N.R. ; Ford, L.G. ; Jacobs, E.J. ; jankowski, Janusz ; La Vecchia, C. ; Law, M. ; Meyskens, F. ; Rothwell, P.M. ; Senn, H.J. ; Umar, A. / Estimates of benefits and harms of prophylactic use of aspirin in the general population. In: Annals of Oncology. 2014 ; Vol. 26, No. 1. pp. 47-57.
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    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.",
    author = "J. Cuzick and M.A. Thorat and C. Bosetti and P.H. Brown and J. Burn and N.R. Cook and L.G. Ford and E.J. Jacobs and Janusz jankowski and {La Vecchia}, C. and M. Law and F. Meyskens and P.M. Rothwell and H.J. Senn and A. Umar",
    note = "This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com International Society of Cancer Prevention (ISCaP), Cancer Research UK (CRUK), British Heart Foundation (BHF) and American Cancer Society (ACS) and received funding from CRUK, BHF and ACS",
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    TY - JOUR

    T1 - Estimates of benefits and harms of prophylactic use of aspirin in the general population

    AU - Cuzick, J.

    AU - Thorat, M.A.

    AU - Bosetti, C.

    AU - Brown, P.H.

    AU - Burn, J.

    AU - Cook, N.R.

    AU - Ford, L.G.

    AU - Jacobs, E.J.

    AU - jankowski, Janusz

    AU - La Vecchia, C.

    AU - Law, M.

    AU - Meyskens, F.

    AU - Rothwell, P.M.

    AU - Senn, H.J.

    AU - Umar, A.

    N1 - This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com International Society of Cancer Prevention (ISCaP), Cancer Research UK (CRUK), British Heart Foundation (BHF) and American Cancer Society (ACS) and received funding from CRUK, BHF and ACS

    PY - 2014

    Y1 - 2014

    N2 - 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.

    AB - 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.

    U2 - 10.1093/annonc/mdu225

    DO - 10.1093/annonc/mdu225

    M3 - Article

    VL - 26

    SP - 47

    EP - 57

    JO - Annals of Oncology

    JF - Annals of Oncology

    SN - 0923-7534

    IS - 1

    ER -