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Aspirin in the prevention of cancer
Although Peter Rothwell and colleagues1 provide the strongest evidence to date for the effect of aspirin in cancer prevention, they do not consider the well known adverse effects of aspirin, and focused on one potential benefit of aspirin in a study largely confined to middle-aged men.
Risk and benefit increase with age.2 Although the results look impressive when presented in proportional reduction terms, they are less so in “real” terms (14 000 people took aspirin for at least 4 years for a saving of about 100 cancer deaths). It is important, therefore, to be aware that a small proportion of those who develop serious adverse events, such as haemorrhagic stroke and major gastrointestinal bleeding, could reduce or reverse the benefit.2—4
In older people, for whom serious adverse events are much more common and their consequences potentially more serious, the risk/benefit equation will probably be different. The ASPirin in Reducing Events in the Elderly (ASPREE) trial5 examines whether the benefits of daily aspirin outweigh the risks in people aged 70 years or older. The ASPREE primary endpoint is extension of life free from dementia and disability. The trial will be able to show the true overall benefit of routine use of aspirin in older people for primary prevention beyond simply counting individual adverse events.
I have received travel support from Bayer Healthcare—a manufacturer of aspirin. This company is also providing aspirin for ASPREE, of which I am a principal investigator.