The recent paper by Cuzick and colleagues in the Annals of Oncology collated findings from the most recent systematic reviews that looked at the effect of aspirin for site-specific cancer incidence and mortality.
They showed that taking low-dose aspirin for 10 years starting at any time between the ages of 50–60 results in a 20% reduction in all cancer mortality, with 30-45% reductions in the risk of dying from oesophageal, gastric and colorectal cancer.
On the other hand, the combined data show aspirin is associated with a 70% increase in fatal gastrointestinal bleeds – raising the risk from a baseline of 0.7 per 1000 per year to 1.19 per 1000 per year.
There are a number of Cancer Research UK trials underway that may provide further information and guidance may be developed in the months to come, but in the meantime what should we be saying?
The line I will be taking is to assess the patient’s family history – for colorectal cancer and gastric cancer. A family history at least doubles your own risk – and the risk from taking aspirin, including whether they are on anticoagulants, have a past medical history of peptic ulceration, are over 70, have diabetes or hypertension, are obese, smoke or have excessive alcohol intake.
Also some patients with asthma are sensitive to taking aspirin, so in these cases it would not be a suitable course of action.
If there is family history, and there are no ‘bleeding’ risk factors, I would recommend starting aspirin 75 mg once a day for 10 years – ensuring the risk is discussed and recorded, and potential side effects are discussed. This line would tick my personal ‘friend and family test’.
The views about treatment are my own, and not those of any organisation I represent.
Dr Richard Roope is the RCGP clinical lead for cancer and a GP in Hampshire.