BackgroundDaily aspirin reduces the long-term incidence of some adenocarcinomas, but effects on mortality due to some cancers appear after only a few years, suggesting that it might also reduce growth or metastasis. We established the frequency of distant metastasis in patients who developed cancer during trials of daily aspirin versus control.
MethodsOur analysis included all five large randomised trials of daily aspirin (≥75 mg daily) versus control for the prevention of vascular events in the UK. Electronic and paper records were reviewed for all patients with incident cancer. The effect of aspirin on risk of metastases at presentation or on subsequent follow-up (including post-trial follow-up of in-trial cancers) was stratified by tumour histology (adenocarcinoma vs other) and clinical characteristics.
FindingsOf 17 285 trial participants, 987 had a new solid cancer diagnosed during mean in-trial follow-up of 6·5 years (SD 2·0). Allocation to aspirin reduced risk of cancer with distant metastasis (all cancers, hazard ratio [HR] 0·64, 95% CI 0·48—0·84, p=0·001; adenocarcinoma, HR 0·54, 95% CI 0·38—0·77, p=0·0007; other solid cancers, HR 0·82, 95% CI 0·53—1·28, p=0·39), due mainly to a reduction in proportion of adenocarcinomas that had metastatic versus local disease (odds ratio 0·52, 95% CI 0·35—0·75, p=0·0006). Aspirin reduced risk of adenocarcinoma with metastasis at initial diagnosis (HR 0·69, 95% CI 0·50—0·95, p=0·02) and risk of metastasis on subsequent follow-up in patients without metastasis initially (HR 0·45, 95% CI 0·28—0·72, p=0·0009), particularly in patients with colorectal cancer (HR 0·26, 95% CI 0·11—0·57, p=0·0008) and in patients who remained on trial treatment up to or after diagnosis (HR 0·31, 95% CI 0·15—0·62, p=0·0009). Allocation to aspirin reduced death due to cancer in patients who developed adenocarcinoma, particularly in those without metastasis at diagnosis (HR 0·50, 95% CI 0·34—0·74, p=0·0006). Consequently, aspirin reduced the overall risk of fatal adenocarcinoma in the trial populations (HR 0·65, 95% CI 0·53—0·82, p=0·0002), but not the risk of other fatal cancers (HR 1·06, 95% CI 0·84—1·32, p=0·64; difference, p=0·003). Effects were independent of age and sex, but absolute benefit was greatest in smokers. A low-dose, slow-release formulation of aspirin designed to inhibit platelets but to have little systemic bioavailability was as effective as higher doses.
InterpretationThat aspirin prevents distant metastasis could account for the early reduction in cancer deaths in trials of daily aspirin versus control. This finding suggests that aspirin might help in treatment of some cancers and provides proof of principle for pharmacological intervention specifically to prevent distant metastasis.
Aspirin is prescribed for high cholesterol,it also causes intestinal bleeding.
Pain killers cause serious after effects.
Scans increase the risk to cancer.
Diuretics damage kidneys.
Cancer inducing genes identified now;yet we have already cured it.
Caffeine was perceived to be carcinogenic;now it reduces cancer risk also prevents heart disease.
Take any medicine, you have the same ambivalence.
Or take any prognosis-as many number of opinions as that of specialists.
Is Medicine a Science?
Post menopausal women who take anti-depressants face a small – but statistically significant – increased risk of a stroke, research suggests.
The US study was based on 136,293 women aged 50 to 79, who were followed for an average of six years.
Anti-depressant users were 45% more likely to have a stroke than women not taking the drugs.
The data, published in Archives of Internal Medicine, is taken from the Women’s Health Initiative Study.
When overall death rates were examined, those on anti-depressants were found to have a 32% higher risk of death from all causes during the study than non-users.
The researchers stressed that the overall risk of a stroke was relatively small. Even for women on anti-depressants, it was less than one in 200 chance in any given year.
You have to weigh the benefits that you get from these anti-depressants against the small increase in risk that we found in this study
Dr Sylvia Wassertheil-Smoller
Albert Einstein College of Medicine
However, they said that because so many women were taking anti-depressants the effect would be significant across the entire population.
It is not clear whether taking anti-depressants is solely responsible for the increased risk of a stroke.
Depression itself is known to be a risk factor for cardiovascular problems.
The researchers tried to take this into account in their analysis of the data – but could not rule out the possibility that it influenced the final results.
The study found no difference in stroke risk between the two major classes of anti-depressants, selective serotonin reuptake inhibitors (SSRIs) or tricyclic anti-depressants (TCAs).
However, the SSRIs did appear to convey a higher risk of hemorrhagic stroke caused by a bleed in the brain.
Lead researcher Dr Sylvia Wassertheil-Smoller, of Albert Einstein College of Medicine, stressed that treatment for depression was important, and that women should not stop taking prescribed medication without first consulting their doctor.
She said: “You have to weigh the benefits that you get from these antidepressants against the small increase in risk that we found in this study.”
The researchers said follow-up studies were needed before any firm conclusions could be drawn.
Dr Jordan Smoller, of Harvard Medical School, who also worked on the study, said: “We need to study this association more to determine exactly what it signifies.”
Joanne Murphy, for The Stroke Association stressed the study showed that overall risk for women taking anti-depressants was relatively small.
She said “We are already aware of links between depression and the risk of stroke and we are currently funding further studies to look into this.
“Everyone can help reduce their risk of stroke by making lifestyle changes, such as reducing their blood pressure, giving up smoking, reducing alcohol intake, improving their diet and getting plenty of exercise.”
Ellen Mason, of the British Heart Foundation, said: “Severe depression can be debilitating and even fatal, so it is important to weigh up any small increase in the risk of stroke with the benefits of treating depression.”
Bridget O’Connell, from the mental health charity Mind, said antidepressants produced a range of side effects that affected people in different ways.
She said: “Many people can experience huge benefits from taking antidepressants and it’s important they work with their GP to identify both the plus points and the drawbacks, and weigh up what treatment is best for them.”