Aspirin

Recently, I saw a 36 year old man in my office with bowel problems. His first question was: Doc, should I take an aspirin a day to prevent colon cancer?

First, let us look back in history.

Hippocrates and the Indians of North America have known the pain killing properties of willow bark, which contains salicylates (aspirin is acetylsalicylic acid), for many hundred years.

Besides it being a painkiller, it also reduces inflammation and fever. Commercially, aspirin became available in 1899 as a result of a search by Felix Hoffman at Bayer Industries to help his father who suffered from rheumatoid arthritis.

By the 1960s, aspirin became the most widely used pharmaceutical product in the world. For example, in U. S. alone, the annual production of aspirin is over 15,000 tons (13,600 metric tons).

In 1985, researchers first established that aspirin can prevent heart attacks. If you have chest pain and are suffering a heart attack, then taking an aspirin will reduce your chance of dying from heart attack by 25 per cent. It also reduces the risk of a second heart attack by 50 per cent. For patients who have suffered a stroke, it offers protection from a second one.

So, what about cancer prevention?

For the last 25 years, researchers have been saying that aspirin, ibuprofen and other anti-inflammatory drugs may play a role in preventing cancer. Studies have found that it could reduce the risk of both colorectal cancer and mouth and throat cancers by two-thirds.

In one recent study, women who took a single ibuprofen tablet at least three days a week for 10years or more saw their risk of breast cancer fall by 49 per cent.

Women who regularly took aspirin saw their risk of breast cancer drop by only 28 per cent.

There is also some evidence that ibuprofen may offer more protection from Alzheimer’s disease. Canadian researchers have shown that ibuprofen may reduce the risk of getting Alzheimer’s by up to 30 per cent.

If this is all true then why physicians do not promote the use of aspirin and ibuprofen as a prophylactic for cancer prevention?

The above findings are from retrospective studies – they look back at men or women who were taking these products for other illnesses and see if they suffered from specific cancers compared to those who did not take aspirins or ibuprofens.

There are no prospective randomized double blind trials to prove that aspirin or ibuprofen is what prevents cancer. There may be other variables which may influence the outcome. Prospective randomized double blind trials eliminate those variables.

Many doctors are cautious about the idea of healthy people taking aspirin or ibuprofen in the hope of preventing disease. More studies are needed to confirm that the benefits outweigh the risks. They don’t know what dose is appropriate, or how many years the drugs must be taken before they offer protection.

These drugs are not always harmless. Internal bleeding is a serious risk. The painkillers can also interact dangerously with other drugs.

Recently, the Globe and Mail wrote, “Randall Harris, a respected professor of epidemiology at Ohio State University, didn’t follow the cautious approach when he announced the results of the breast-cancer study. Instead of recommending waiting until more studies are done, he urged women over the age of 40 to talk to their doctors about taking a standard dose of ibuprofen (200 milligrams) or aspirin (325 mg) daily.”

But there are other reports which say that taking ibuprofen may undo the protective effect of aspirin.

Are you confused? So are the doctors! But my answer to the young man is – there are many other ways of preventing cancer (remember ELMOSS?) – rather than looking for a miracle drug.

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