Introduction: Role of aspirin and other NSAIDs in cancer prevention


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Jack Cuzick
Wolfson Institute of Preventative Medicine, London, UK

Abstract

Recently there has been much new evidence on the role of aspirin in the prevention of cancer. Early studies focussed on colorectal cancer, but more recent studies suggest the preventive effects may be more widespread extending to oesophageal and stomach cancer, and possibly less strongly to breast, prostate and lung cancers, with some evidence to other cancers as well. The effect on mortality appears to be greater than for incidence leading the possibility that aspirin may also have a role in adjuvant treatment, which is currently being evaluated for colorectal cancer.

The major concern about using aspirin in the general population relates to an increase of bleeding events, particularly gastro-intestinal bleeding, but also more rarely haemorrhagic strokes. Thus careful benefit-harm assessments are needed both overall and for individuals. Identifying individuals at increased risk of bleeding is an important activity and concurrent with H. pylori emerges as an important consideration. The relative effectiveness and safety of other NSAIDs is also an area of interest.

Several uncertainties remain as to how it should be used in the preventive setting including age and duration of use, sex differences in outcome and the appropriate dose for cancer prevention. In this session Prof. Nancy Cook will review evidence from randomised clinical trials, followed by a review of the observational studies by Prof. Carlo LaVecchia. Prof. John Burn will then examine its role in high risk populations for specific cancers (e.g. Lynch syndrome patients) and the evidence for an effect on recurrence in patients with existing cancers.