Aspirin use may reduce the risk for death among older patients with bladder or breast cancer, a new study finds.

Holli A. Loomans-Kropp, PhD, MPH, of the National Cancer Institute in Rockville, Maryland, and colleagues studied data from 139,896 individuals aged 65 years or older (51.4% female; 88.5% non-Hispanic White) from the Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) Screening Trial. Of the cohort, 5.4% had bladder, 14.0% breast, 1.0% esophageal, 1.2% gastric, 2.7% pancreatic, and 2.2% uterine cancer (other cancers were excluded).

Multivariable regression analysis showed that taking aspirin at least 3 times per week was significantly associated with a 33% and 25% reduced risk for mortality among older patients with bladder and breast cancer, respectively, Dr Loomans-Kropp’s team reported in JAMA Network Open. Similarly, any aspirin use was significantly associated with a 25% and 21% reduced mortality risk among these patients, respectively. Aspirin dose was not included in the analysis, which is a limitation. The investigators adjusted for age at diagnosis, PLCO randomization group, sex, race, smoking status, and history of heart attack, stroke, hypertension, and diabetes.

A 2018 study of radical cystectomy patients, published in the Journal of Urology, similarly found that daily aspirin was significantly associated with higher 5-year cancer-specific (68% vs 60%) and overall survival (59% vs 52%) compared with nonuse.


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Notably, aspirin use was not associated with incidence of any of the investigated cancer types in the current PLCO cohort. The team also found no survival benefit among older patients with esophageal, gastric, pancreatic, or uterine cancer taking aspirin.

“The results presented here add to the accumulating evidence that aspirin may improve survival for some cancers,” Dr Loomans-Kropp’s team stated. “Although prior research has been most heavily concentrated in gastrointestinal cancers, our analysis extends the advantages associated with aspirin use to other cancers, such as bladder and breast cancers.”

With respect to potential mechanisms, the synthesis or activity of cyclooxygenase-2 is increased in bladder and breast cancers and aspirin is an inhibitor, the study authors noted. Although aspirin may have a survival effect in older patients with certain cancers, clinicians must consider the potential harms of long-term use.

References

Loomans-Kropp HA, Pinsky P, Umar A. Evaluation of aspirin use with cancer incidence and survival among older adults in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Published: January 15, 2021. JAMA Netw Open. doi:10.1001/jamanetworkopen.2020.32072

Lyon TD, Frank I, Shah PH, et al. The association of aspirin use with survival following radical cystectomy. J Urol. 2018;200(5):1014-1021. doi:10.1016/j.juro.2018.05.119