A total of , aspirin users and , non-aspirin users were included, with the mean age Cancer incidences were found in 26, Compared with patients who had not been prescribed aspirin, aspirin usage led to significant reduction of cancers in liver RR: 0.
There was no demonstrable reduction of kidney cancer, bladder cancer, prostate cancer and multiple myeloma in association with the usage of aspirin. Risk of breast cancer was shown to marginally increase RR: 1. This trial closed in But results are not yet available. Aspirin and a drug called ticagrelor block platelets. Platelets are blood cells. They help the blood to clot when there is an injury. Researchers know that circulating cancer cells interact with platelets in the blood. This may help protect the cancer cells and spread them throughout the body.
Researchers want to find out if blocking platelets may affect how cancer spreads. This study closed in Results are not yet available. So, there are still some unanswered questions about aspirin and cancer. We need to know which dose works best to lower the risk of cancer developing or spreading. This dose must cause the least harm. Remember, there are other things you can do to lower your risk of developing cancer. These include:. Our clinical trials aim to find out if a new treatment or procedure is safe, is better than the current treatment or helps you feel better.
There are many different types of cancer drugs. Some treat cancer and others help to relieve symptoms such as sickness and pain. The type of drugs you need for your cancer depends on what type of cancer you have.
You might have a combination of drugs. Knowing more about how these drugs work, how you have them and their possible side effects can help you cope with treatment. Treatments can include surgery, radiotherapy and drug treatments such as chemotherapy, hormone therapy or targeted cancer drugs. Find out about treatments and how to cope with side effects. Coping with cancer can be difficult. There is help and support available. Find out about the emotional, physical and practical effects of cancer and how to manage them.
Search for the cancer type you want to find out about. Each section has detailed information about symptoms, diagnosis, treatment, research and coping with cancer. About Cancer generously supported by Dangoor Education since Questions about cancer? Early in , the U. Preventive Services Task Force USPSTF has issued a clinical recommendation that a routine use of low-dose aspirin for the primary prevention of CVDs in the elderly is likely to yield substantial additional benefits with regard to CRC prevention, reflecting the accumulating evidence for a chemopreventive effect of low-dose aspirin against cancer Aspirin is distinguished as a promising pharmacologic agent for chemoprevention of cancer.
New research has reinforced the idea that long-term low-dose aspirin intake may inhibit cancer cell proliferation and metastasis 12 , Findings from observational studies continue to hint at the anti-cancer potential of aspirin against a variety of cancers 14 — The USPSTF findings emphasized the need for more research efforts in evaluating the preventive effects of aspirin on different cancer sites.
The associations between aspirin intake and the risk of a wide range of cancers e. Assessing evidence from every possible source is therefore needed before the role of aspirin in clinical practice can be more clearly defined.
This meta-analysis included cohort studies and randomised controlled trials RCTs that assessed the effects of aspirin on common cancers. By exploring the relationship between aspirin use and common cancer risk, we aimed to provide evidence for cancer-related implications of aspirin use. The study will not only inform patient-physician decision-making about the optimal use of aspirin, but also be of significant value to the research community.
Medline and EMBASE databases were systematically searched from inception to 16 October by using a comprehensive search strategy Supplementary Table 1 to identify relevant studies. All identified records went through a three-step parallel review of title, abstract and full text based on pre-defined inclusion and exclusion criteria.
Two investigators L. In case of any discrepancy, the final decision was made after discussion. This study included cohort studies and RCTs intervention with aspirin intake vs.
Outcomes of interest included cancer incidence and mortality. When multiple reports were published based on the same study, either the most recent one with the longest period of follow-up or the one with the most comprehensive data was included. We excluded i studies that investigated associations between aspirin and non-cancer outcomes; ii studies that evaluated non-oral forms or derivatives of aspirin; iii RCTs that included interventions of non-aspirin antithrombotic medications e.
For each eligible study, data were extracted on first author, year of publication, study population and settings, cancer outcomes, the number of events and sample size, aspirin use categories according to frequency e. Data extraction was performed by one investigator L. Heterogeneity among studies was first detected using Cochran Q test and the I square metric Otherwise, a fixed-effect model was used for meta-analysis.
The sub-group analyses were conducted to explore the influence of exposure variations on cancer risk. For cancer-specific mortality, the analyses were stratified into pre-diagnostic and post-diagnostic subgroups according to the use of aspirin before and after cancer diagnosis, respectively. All statistical analyses were conducted in R version 4.
To examine the potential non-linear trend of aspirin use and cancer risk, a dose-response analysis was performed. For each study, the daily aspirin dose was assigned to the corresponding RR estimate. The mid-point of the upper and lower boundaries in each category was assigned if the exact measurements were not available. Non-linear regression was used to fit data to a model that defined the response RR of developing a certain cancer as a function of dose aspirin use measurement.
Dose-response curves were used to present the dose-response relationships between aspirin use and cancer risk. For outcomes that were investigated in both the meta-analysis of cohort studies and the meta-analysis of RCTs, the direction and statistical significance of the estimates were compared across the meta-analyses.
A total of 5, articles were retrieved from two databases. After screening of title, abstract and full text, 94 eligible articles were finally included Figure 1. There was one study with a combination of RCT and cohort design resulting the total number of 94 unique studies included for meta-analysis. The overall effects of aspirin use on cancer outcomes are summarized in Tables 1 , 2 and main characteristics of included studies are presented in Supplementary Tables 2, 3.
Figure 1 Flow chart of study selection for meta-analysis. For RCTs, number of studies represents the total number of studies included in the meta-analysis for the specific cancer and number of trials is the total number of clinical trials included in the meta-analysis. The inconsistency between these two numbers is due to that some studies used individual patient data from multiple trials for analysis.
Table 1 Up-to-date meta-analyses of cohort studies for 8 cancer outcomes and classification of evidence credibility. Table 2 Up-to-date meta-analyses of RCTs for 9 cancer outcomes and classification of evidence credibility. Colorectal cancer : 18 studies with a total of , events and 3,, participants were included for the meta-analysis of CRC incidence.
Excessive significance bias and small study effects were indicated for the summary estimate of any regular use Figure 2 and Supplementary Figure 1. Figure 2 Forest plot of aspirin use in different categories and risk of common cancers in cohort studies. Gastric cancer : 10 studies were identified for the meta-analysis of gastric cancer with 14, events and 2,, participants. Breast cancer : Meta-analysis for breast cancer included 26 studies with 31, events and 2,, participants.
However, subgroup analyses of daily or long-duration aspirin use revealed non-significant summary estimates Supplementary Figure 3. Prostate cancer : 20 studies, with a total of 81, events and 2,, participants, examined the association between aspirin use and prostate cancer risk. Meta-analyses of daily use seven studies and long-duration use 11 studies revealed non-significant associations Supplementary Figure 4.
Lung cancer : Meta-analysis of 11 studies with 37, cases and 1,, participants found inconsistent results for the association between aspirin use and lung cancer risk.
Cancer mortality : Meta-analyses of pre-diagnostic and post-diagnostic aspirin use on cancer-specific mortality in cancer patients were performed for CRC totally 11 unique studies, six studies reporting data on pre-diagnosis use, eight studies reporting data on post-diagnosis use , breast cancer 10 unique studies in total, five studies reporting data on pre-diagnosis use, eight studies reporting data on post-diagnosis use and prostate cancer totally nine studies, three studies reporting data on pre-diagnosis use, seven studies reporting data on post-diagnosis use.
Figure 3 Forest plot of aspirin use in different categories and cancer specific mortality in cohort studies. The robustness of these summary estimates was then assessed using pre-defined evidence classification criteria Supplementary Box 1. Due to the presence of considerable heterogeneity, excessive significance bias or small study effects, none of the observed associations qualified as convincing Class I or highly suggestive Class II evidence.
There was weak evidence class IV for the associations between aspirin use and the following outcomes: the reduced risk of CRC incidence with daily and long-duration aspirin use and mortality aspirin use after cancer diagnosis , gastric cancer incidence with any regular and long-duration aspirin use , breast cancer incidence with any regular aspirin use and mortality aspirin use after cancer diagnosis , prostate cancer incidence with any regular aspirin use , and the increased risk of lung cancer incidence with daily aspirin use.
The remaining assessed cancer outcomes presented non-significant summary estimates in relation to aspirin use. Figure 4 Forest plot of aspirin use in different categories and risk of common cancers in RCTs. Figure 5 Forest plot of aspirin use in different categories and cancer specific mortality in RCTs. Overall, there were five common cancers with meta-analyses results available from both cohort studies and RCTs Table 3. Disagreement in either the direction or statistical significance of the summary estimates between meta-analyses of cohort studies and RCTs was seen for gastric, breast and prostate cancer.
Both meta-analyses of cohort studies and RCTs showed non-significant summary estimates for lung cancer risk. Table 3 Comparison of overlapping cancer outcomes examined in meta-analyses of cohort studies and RCTs. Figure 6 presents the dose-response relationship of aspirin use with cancer risk. There was a non-linear relationship between aspirin dose and prostate cancer risk. The estimated RRs of developing prostate cancer reduced with the increment of aspirin dose and reached 0.
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