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Effect of aspirin on cancer incidence and mortality in older adults


McNeil, JJ and Gibbs, P and Orchard, SG and Lockery, JE and Bernstein, WB and Cao, Y and Ford, L and Haydon, A and Kirpach, B and Macrae, F and McLean, C and Millar, J and Murray, A and Nelson, MR and Polekhina, G and Reid, CM and Richmond, E and Rodriguez, LM and Shah, RC and Tie, J and Umar, A and van Londen, GJ and Ronaldson, K and Wolfe, R and Woods, RL and Zalcberg, J and Chan, AT, on behalf of the ASPREE Investigator Group, Effect of aspirin on cancer incidence and mortality in older adults, Journal of the National Cancer Institute, 113, (3) pp. 258-265. ISSN 0027-8874 (2020) [Refereed Article]

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Copyright 2020 The Authors. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)

DOI: doi:10.1093/jnci/djaa114


Background: ASPirin in Reducing Events in the Elderly (ASPREE), a randomized double-blind placebo-controlled trial (RCT) of daily low-dose aspirin (100 mg) in older adults, showed an increase in all-cause mortality, primarily due to cancer. In contrast prior RCTs, mainly involving younger individuals, demonstrated a delayed cancer benefit with aspirin. We now report a detailed analysis of cancer incidence and mortality.

Methods: 19,114 Australian and U.S. community-dwelling participants aged 70+ years (U.S. minorities 65+ years) without cardiovascular disease, dementia or physical disability were randomized and followed for a median of 4.7 years. Fatal and non-fatal cancer events, a prespecified secondary endpoint, were adjudicated based on clinical records.

Results: 981 cancer events occurred in the aspirin and 952 in the placebo groups. There was no statistically significant difference between groups for all incident cancers (HR = 1.04, 95% CI = 0.95 to 1.14), hematological cancer (HR = 0.98, 95% CI = 0.73 to 1.30), or all solid cancers (HR = 1.05, 95% CI = 0.95 to 1.15), including by specific tumor type. However, aspirin was associated with an increased risk of incident cancer that had metastasized (HR = 1.19, 95% CI = 1.00 to 1.43) or was stage 4 at diagnosis (HR = 1.22, 95% CI = 1.02 to 1.45), and with higher risk of death for cancers that presented at stages 3 (HR = 2.11, 95% CI = 1.03 to 4.33) or 4 (HR = 1.31, 95% CI = 1.04 to 1.64).

Conclusions: In older adults, aspirin treatment had an adverse effect on later stages of cancer evolution. These findings suggest that in older persons, aspirin may accelerate the progression of cancer and thus, suggest caution with its use in this age group.

Item Details

Item Type:Refereed Article
Research Division:Biomedical and Clinical Sciences
Research Group:Oncology and carcinogenesis
Research Field:Cancer cell biology
Objective Division:Health
Objective Group:Specific population health (excl. Indigenous health)
Objective Field:Health related to ageing
UTAS Author:Nelson, MR (Professor Mark Nelson)
ID Code:141789
Year Published:2020
Web of Science® Times Cited:57
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-11-19
Last Modified:2022-08-29
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