Estimates of benefits and harms of prophylactic use of aspirin in the general population

Accumulating evidence supports an effect of aspirin in reducing overall cancer incidence and mortality in the general population. We reviewed current data and assessed the benefits and harms of prophylactic use of aspirin in the general population. The effect of aspirin for site-specific cancer inci...

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Veröffentlicht in:	Annals of oncology Jg. 26; H. 1; S. 47 - 57
Hauptverfasser:	Cuzick, J, Thorat, M A, Bosetti, C, Brown, P H, Burn, J, Cook, N R, Ford, L G, Jacobs, E J, Jankowski, J A, La Vecchia, C, Law, M, Meyskens, F, Rothwell, P M, Senn, H J, Umar, A
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	England 01.01.2015
Schlagworte:	Anti-Inflammatory Agents, Non-Steroidal - adverse effects Anti-Inflammatory Agents, Non-Steroidal - therapeutic use Aspirin - adverse effects Aspirin - therapeutic use Female Gastrointestinal Hemorrhage - chemically induced Humans Male Myocardial Infarction - prevention & control Neoplasms - prevention & control Stroke - prevention & control cardiovascular disease aspirin cancer prevention benefit-harm gastrointestinal bleeding
ISSN:	1569-8041, 1569-8041
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Abstract	Accumulating evidence supports an effect of aspirin in reducing overall cancer incidence and mortality in the general population. We reviewed current data and assessed the benefits and harms of prophylactic use of aspirin in the general population. The effect of aspirin for site-specific cancer incidence and mortality, cardiovascular events was collated from the most recent systematic reviews. Studies identified through systematic Medline search provided data regarding harmful effects of aspirin and baseline rates of harms like gastrointestinal bleeding and peptic ulcer. The effects of aspirin on cancer are not apparent until at least 3 years after the start of use, and some benefits are sustained for several years after cessation in long-term users. No differences between low and standard doses of aspirin are observed, but there were no direct comparisons. Higher doses do not appear to confer additional benefit but increase toxicities. Excess bleeding is the most important harm associated with aspirin use, and its risk and fatality rate increases with age. For average-risk individuals aged 50-65 years taking aspirin for 10 years, there would be a relative reduction of between 7% (women) and 9% (men) in the number of cancer, myocardial infarction or stroke events over a 15-year period and an overall 4% relative reduction in all deaths over a 20-year period. Prophylactic aspirin use for a minimum of 5 years at doses between 75 and 325 mg/day appears to have favourable benefit-harm profile; longer use is likely to have greater benefits. Further research is needed to determine the optimum dose and duration of use, to identify individuals at increased risk of bleeding, and to test effectiveness of Helicobacter pylori screening-eradication before starting aspirin prophylaxis.
AbstractList	Accumulating evidence supports an effect of aspirin in reducing overall cancer incidence and mortality in the general population. We reviewed current data and assessed the benefits and harms of prophylactic use of aspirin in the general population.BACKGROUNDAccumulating evidence supports an effect of aspirin in reducing overall cancer incidence and mortality in the general population. We reviewed current data and assessed the benefits and harms of prophylactic use of aspirin in the general population.The effect of aspirin for site-specific cancer incidence and mortality, cardiovascular events was collated from the most recent systematic reviews. Studies identified through systematic Medline search provided data regarding harmful effects of aspirin and baseline rates of harms like gastrointestinal bleeding and peptic ulcer.METHODSThe effect of aspirin for site-specific cancer incidence and mortality, cardiovascular events was collated from the most recent systematic reviews. Studies identified through systematic Medline search provided data regarding harmful effects of aspirin and baseline rates of harms like gastrointestinal bleeding and peptic ulcer.The effects of aspirin on cancer are not apparent until at least 3 years after the start of use, and some benefits are sustained for several years after cessation in long-term users. No differences between low and standard doses of aspirin are observed, but there were no direct comparisons. Higher doses do not appear to confer additional benefit but increase toxicities. Excess bleeding is the most important harm associated with aspirin use, and its risk and fatality rate increases with age. For average-risk individuals aged 50-65 years taking aspirin for 10 years, there would be a relative reduction of between 7% (women) and 9% (men) in the number of cancer, myocardial infarction or stroke events over a 15-year period and an overall 4% relative reduction in all deaths over a 20-year period.RESULTSThe effects of aspirin on cancer are not apparent until at least 3 years after the start of use, and some benefits are sustained for several years after cessation in long-term users. No differences between low and standard doses of aspirin are observed, but there were no direct comparisons. Higher doses do not appear to confer additional benefit but increase toxicities. Excess bleeding is the most important harm associated with aspirin use, and its risk and fatality rate increases with age. For average-risk individuals aged 50-65 years taking aspirin for 10 years, there would be a relative reduction of between 7% (women) and 9% (men) in the number of cancer, myocardial infarction or stroke events over a 15-year period and an overall 4% relative reduction in all deaths over a 20-year period.Prophylactic aspirin use for a minimum of 5 years at doses between 75 and 325 mg/day appears to have favourable benefit-harm profile; longer use is likely to have greater benefits. Further research is needed to determine the optimum dose and duration of use, to identify individuals at increased risk of bleeding, and to test effectiveness of Helicobacter pylori screening-eradication before starting aspirin prophylaxis.CONCLUSIONSProphylactic aspirin use for a minimum of 5 years at doses between 75 and 325 mg/day appears to have favourable benefit-harm profile; longer use is likely to have greater benefits. Further research is needed to determine the optimum dose and duration of use, to identify individuals at increased risk of bleeding, and to test effectiveness of Helicobacter pylori screening-eradication before starting aspirin prophylaxis. BACKGROUNDAccumulating evidence supports an effect of aspirin in reducing overall cancer incidence and mortality in the general population. We reviewed current data and assessed the benefits and harms of prophylactic use of aspirin in the general population.METHODSThe effect of aspirin for site-specific cancer incidence and mortality, cardiovascular events was collated from the most recent systematic reviews. Studies identified through systematic Medline search provided data regarding harmful effects of aspirin and baseline rates of harms like gastrointestinal bleeding and peptic ulcer.RESULTSThe effects of aspirin on cancer are not apparent until at least 3 years after the start of use, and some benefits are sustained for several years after cessation in long-term users. No differences between low and standard doses of aspirin are observed, but there were no direct comparisons. Higher doses do not appear to confer additional benefit but increase toxicities. Excess bleeding is the most important harm associated with aspirin use, and its risk and fatality rate increases with age. For average-risk individuals aged 50-65 years taking aspirin for 10 years, there would be a relative reduction of between 7% (women) and 9% (men) in the number of cancer, myocardial infarction or stroke events over a 15-year period and an overall 4% relative reduction in all deaths over a 20-year period.CONCLUSIONSProphylactic aspirin use for a minimum of 5 years at doses between 75 and 325mg/day appears to have favourable benefit-harm profile; longer use is likely to have greater benefits. Further research is needed to determine the optimum dose and duration of use, to identify individuals at increased risk of bleeding, and to test effectiveness of Helicobacter pylori screening-eradication before starting aspirin prophylaxis. Accumulating evidence supports an effect of aspirin in reducing overall cancer incidence and mortality in the general population. We reviewed current data and assessed the benefits and harms of prophylactic use of aspirin in the general population. The effect of aspirin for site-specific cancer incidence and mortality, cardiovascular events was collated from the most recent systematic reviews. Studies identified through systematic Medline search provided data regarding harmful effects of aspirin and baseline rates of harms like gastrointestinal bleeding and peptic ulcer. The effects of aspirin on cancer are not apparent until at least 3 years after the start of use, and some benefits are sustained for several years after cessation in long-term users. No differences between low and standard doses of aspirin are observed, but there were no direct comparisons. Higher doses do not appear to confer additional benefit but increase toxicities. Excess bleeding is the most important harm associated with aspirin use, and its risk and fatality rate increases with age. For average-risk individuals aged 50-65 years taking aspirin for 10 years, there would be a relative reduction of between 7% (women) and 9% (men) in the number of cancer, myocardial infarction or stroke events over a 15-year period and an overall 4% relative reduction in all deaths over a 20-year period. Prophylactic aspirin use for a minimum of 5 years at doses between 75 and 325 mg/day appears to have favourable benefit-harm profile; longer use is likely to have greater benefits. Further research is needed to determine the optimum dose and duration of use, to identify individuals at increased risk of bleeding, and to test effectiveness of Helicobacter pylori screening-eradication before starting aspirin prophylaxis.
Author	Jacobs, E J La Vecchia, C Senn, H J Law, M Thorat, M A Rothwell, P M Brown, P H Cuzick, J Cook, N R Bosetti, C Umar, A Ford, L G Meyskens, F Burn, J Jankowski, J A
Author_xml	– sequence: 1 givenname: J surname: Cuzick fullname: Cuzick, J email: j.cuzick@qmul.ac.uk organization: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK. Electronic address: j.cuzick@qmul.ac.uk – sequence: 2 givenname: M A surname: Thorat fullname: Thorat, M A organization: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK – sequence: 3 givenname: C surname: Bosetti fullname: Bosetti, C organization: Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy – sequence: 4 givenname: P H surname: Brown fullname: Brown, P H organization: Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, USA – sequence: 5 givenname: J surname: Burn fullname: Burn, J organization: Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK – sequence: 6 givenname: N R surname: Cook fullname: Cook, N R organization: Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston – sequence: 7 givenname: L G surname: Ford fullname: Ford, L G organization: Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda – sequence: 8 givenname: E J surname: Jacobs fullname: Jacobs, E J organization: Epidemiology Research Program, American Cancer Society, Atlanta, USA – sequence: 9 givenname: J A surname: Jankowski fullname: Jankowski, J A organization: Centre for Biomedical Research-Translational and Stratified Medicine, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth; Centre for Digestive Diseases, Blizard Institute of Cell and Molecular Science, Queen Mary University of London, London, UK – sequence: 10 givenname: C surname: La Vecchia fullname: La Vecchia, C organization: Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy – sequence: 11 givenname: M surname: Law fullname: Law, M organization: Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK – sequence: 12 givenname: F surname: Meyskens fullname: Meyskens, F organization: Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, USA – sequence: 13 givenname: P M surname: Rothwell fullname: Rothwell, P M organization: Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK – sequence: 14 givenname: H J surname: Senn fullname: Senn, H J organization: Tumor and Breast Center ZeTuP, St Gallen, Switzerland – sequence: 15 givenname: A surname: Umar fullname: Umar, A organization: Gastrointestinal and Other Cancers Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, USA
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/25096604$$D View this record in MEDLINE/PubMed
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ContentType	Journal Article
Copyright	The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology.
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References	25098322 - BMJ. 2014 Aug 05;349:g5037. doi: 10.1136/bmj.g5037. 25416686 - Ann Oncol. 2015 Feb;26(2):441-2. doi: 10.1093/annonc/mdu538. 25403580 - Ann Oncol. 2015 Feb;26(2):442-3. doi: 10.1093/annonc/mdu546.
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Snippet	Accumulating evidence supports an effect of aspirin in reducing overall cancer incidence and mortality in the general population. We reviewed current data and... BACKGROUNDAccumulating evidence supports an effect of aspirin in reducing overall cancer incidence and mortality in the general population. We reviewed current...
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SubjectTerms	Anti-Inflammatory Agents, Non-Steroidal - adverse effects Anti-Inflammatory Agents, Non-Steroidal - therapeutic use Aspirin - adverse effects Aspirin - therapeutic use Female Gastrointestinal Hemorrhage - chemically induced Humans Male Myocardial Infarction - prevention & control Neoplasms - prevention & control Stroke - prevention & control
Title	Estimates of benefits and harms of prophylactic use of aspirin in the general population
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