Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Aspirin reduces stomach cancer

The British Journal of Cancer has published the results of an observational prospective cohort study that aimed to assess between use of non-steroidal anti-inflammatory drugs (NSAIDs) and three types of stomach cancer. This story was reported in the wider media (BBC).

Data were collected for 311,115 individuals on self-reported use of aspirin and other NSAIDs and incidence of gastric non-cardia, gastric cardia and oesophageal adenocarcinomas. Aspirin (HR 0.64, 95% CI 0.47–0.86) or other NSAIDs (0.68, 0.51–0.92) was associated with a significantly lower risk of gastric non-cardia adenocarcinoma. There was no association with the other cancers studied.

The authors note that aspirin significantly increases the risk of gastrointestinal bleeding and haemorrhagic stroke and that these potential cancer benefits do not outweigh these risks. The recommend that further research should be conducted in a randomised controlled trial setting to confirm and quantify these findings.

Action: Clinicians should be aware of this study in light of the significant media coverage. NSAIDs cannot currently be recommended to prevent cancer because the benefits do not appear to outweigh the risks.

Thanks to Kevin Ashworth for spotting this article

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One Comments to “Aspirin reduces stomach cancer”

  1. The Bark Of A Willow Tree

    Almost on a daily basis, one may read about a new medication being developed or approved for the benefit of patients with a particular medical condition or disease state that they exist at the time. At times, these announcements may praise the innovation and novelty of such new drugs that are available to all in need of it, and rightfully so, in many situations.
    But it’s possible the one particular drug is not new and really may be a super drug. In fact, it’s one of the oldest medications available, and that would be aspirin- the first non-steroidal anti-inflammatory drug (NSAID) initially for those patients experiencing pain.
    Noted as ASA by doctors typically, aspirin effects have been noted for thousands of years, as the active ingredient comes from the bark of a White Willow tree, and long ago, patients with pain or a fever would chew on this bark for relief. Yet due to the harshness of the natural chemical of this bark, Bayer decided to synthesize it to make it more tolerable for the user.
    Fast forward to over a hundred years ago and Bayer pharmaceuticals (pronounced ‘Beier’), which is the same company that brought us heroin (named so due to its perceived ‘heroic’ qualities as a believed non-addictive substitute for morphine addicts) and mustard gas, as well as methadone.
    The company originated in Germany, but presently has its U.S. headquarters in New York. Felix Hoffman, seeking to develop an agent for his father’s rheumatism, was involved in the development of what is known now as aspirin.
    And it was a difficult task to develop this drug, as it was toxic to the stomach due to the nature of the active ingredient again obtained from the bark of the white willow tree. Dr. Hoffman and others at Bayer developed a drug that proved to be tolerable to patients while keeping the active ingredient in tact through a method of delivery developed by Dr. Hoffman’s team at Bayer.
    After launching the medication, aspirin was priced at about 50 cents an ounce, as at the time it was only available in power form. Soon before 1920, aspirin developed the tablet form of the drug and was then available by prescription. Regardless, aspirin was responsible for one third of sales for Bayer during this time, due to its popularity due to the effects of this medication in need of relief.
    While all drugs have side effects, aspirin is one of very few drugs that offers suitable efficacy with perhaps mild side effects associated with the drug, comparatively speaking. Aspirin has been found to be beneficial for a wide variety of disease states.
    In fact, some of aspirin’s additional uses have been only recently discovered. This may be why the New York Times called aspirin a wonder drug in the 1960s, according to others. In the 1970s, the mechanism of aspirin was isolated, which is the blockage of prostaglandins. Prostaglandins are inside the human body and are a contributor for physiological inflammation.
    Aspirin has been associated with decreased risk of asthma and prostate cancer in the elderly. Also, aspirin has been linked with lowering the risk of breast cancer and colon cancer as well. Yet these conclusions are based on limited research with aspirin.
    Aspirin is a blood thinner, and has been associated with decreasing the risk of heart attacks and strokes in certain patient populations, as the drug prevents clots. However, aspirin has not been shown to prevent heart attacks in diabetic patients.
    The cardiovascular benefits of aspirin were first suggested in the 1940s, and the FDA suggested that it be the drug of choice for those who experienced a heart attack over a decade ago. Aspirin intake is also beneficial for those after coronary bypass procedure. In addition, aspirin has been shown to reduced blood pressure with those who have mild hypertension, if aspirin is taken at night with such patients.
    A topical formulation of aspirin was developed recently for those experiencing Herpes pain. The drug has been proven beneficial for those experiencing migraine pains. Aspirin at low doses is taken by many as a preventive drug to decrease cardiovascular incidents that may occur.
    Aspirin has been the best selling painkiller absent of the past addictive qualities of opiate meds since the 1950s. It is also the most studied drug- with over 3000 scientific papers published worldwide. Also, over 15 billion tablets of aspirin are sold annually, which amounts to about 80 million aspirin tablets consumed daily by others.
    This amounts to over 16,000 tons of aspirin consumed during this time, or about 70,000 metric tons of aspirin a year. Over a decade ago, a study was performed and concluded that twice as many people would choose aspirin over a computer, given the two choices, because of the benefits of the drug.
    Side effects would include GI bleeding if taken in large amounts, along with an association of Reye’s syndrome in children, yet both are relatively rare. Yet all things considered, clearly the benefits of aspirin outweigh any risks of the drug.
    Lately, there have been issues with other NSAIDs, such as Cox II inhibitors, without full recollection or knowledge that aspirin is in fact the world’s most widely used drug, and for good reasons.
    At times, something newer is not always better.
    “There is no genius without a touch of madness.” --- Vaslav Nijinsky
    Dan Abshear

    Comment by Dan — February 28, 2009 #
    Reply

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