- People with certain conditions or a genetic risk of cancer are sometimes prescribed daily aspirin to lower their risk of developing colorectal cancer.
- A new study looks into that preventative possibility among the general population.
- Below, an expert explains the findings.
People with heart disease may be prescribed a daily aspirin tablet to prevent a cardiac event. The same practice is often applied to people with high colon cancer risk because, as an anti-inflammatory, the medication may “interfere with the biological processes that lead to cancer development,” explains Steven Lee-Kong, M.D., chief of colorectal surgery at Hackensack University Medical Center. But a recent study finds that you may not want to take a daily aspirin for colon cancer prevention, despite rising colorectal cancer rates.
Meet the Expert: Steven Lee-Kong, M.D., chief of colorectal surgery at Hackensack University Medical Center.
For the study, published in the Cochrane Database of Systematic Reviews, researchers conducted a systematic review and meta-analysis of 10 randomized controlled trials that involved nearly 125,000 participants who took aspirin daily. Using that data, they assessed the benefits and harms of taking aspirin every day for the primary prevention of colorectal cancer in the general population, not those who have heightened risk due to certain health conditions (such as Lynch syndrome or familial adenomatous polyposis) or those who have a family history of polyps or colon cancer.
As with any non-steroidal anti-inflammatory (NSAID), there are risks associated with taking aspirin long-term—particularly, “serious bleeding in the stomach and brain,” says Dr. Lee-Kong. So, the real question is: Do the pros outweigh the cons?
Researchers categorized their findings into incidences of colorectal cancer and colorectal cancer deaths over certain periods of time. They also looked at incidences of serious extracranial hemorrhage (brain bleeding) and hemorrhagic stroke—two concerns with taking an NSAID long-term.
With moderate certainty, they found that, in healthy people, taking the drug for five to 15 years or less made little to no difference in colorectal cancer incidence. After 15 years of consumption, researchers found, with very low certainty, that aspirin may slightly reduce colorectal cancer incidence.
As for colorectal cancer deaths, researchers found, again, with low certainty, that taking the drug for five to 10 years may increase mortality risk, but may make no to little difference in mortality when taken for 10 to 15 years. Low-certainty evidence also showed that after 15 years or more of taking aspirin, the general population could experience reduced mortality from colon cancer, but, again, the evidence is not strong, Dr. Lee-Kong notes.
The bottom line
“For people who aren’t at high risk for colorectal cancer or cardiovascular disease, taking daily aspirin [may] be harmful because its potential risks outweigh the uncertain benefits. The primary danger is an increased risk of serious bleeding,” says Dr. Lee-Kong.
He continues: “The core issue is a clear imbalance between benefit and harm. The potential benefit of reducing colorectal cancer risk is uncertain, inconsistent, and only appears after very long-term use, with the evidence being of very low certainty. In contrast, the harm—a definite and significant increase in the risk of serious bleeding in the stomach and brain—is immediate and supported by high-certainty evidence.”
So, instead of looking to your medicine cabinet for prevention, Dr. Lee-Kong says that screening is still the gold standard. “The most effective and proven way to prevent colorectal cancer is through regular screening,” he adds. “Colonoscopies and other screening tests can find and remove precancerous polyps before they ever turn into cancer. Aspirin should never be seen as a substitute for on-time colorectal cancer screening.”
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