The U.S. Preventive Services Task Force (USPSTF) recently released draft recommendations on aspirin therapy as a way to treat cardiovascular disease. For the first time, the USPSTF also recommended daily aspirin to protect against colorectal cancer, the third most common type of cancer in the U.S.
Dr. Ari Laliotis, an internal medicine doctor with Sharp Rees-Stealy, explains the role aspirin plays in reducing inflammation, and what patients with a family history of colorectal cancer need to know.
What does the research tell us about the link between aspirin therapy and a reduced risk of colon cancer?
Aspirin is a non-steroid medication that reduces inflammation by inhibiting COX-1 and COX-2. These enzymes are responsible for the production of factors in the body that cause inflammation, pain and fever. It's theorized that reducing chronic inflammation in the gut and colon reduces the formation of precancerous polyps. This — of course — is theoretical and more research needs to be done on the exact mechanisms.
Should people with a family history of colorectal cancer begin aspirin therapy based on these findings?
No. The guidelines do not yet recommend using aspirin solely for the purpose of prevention of colorectal cancer. More studies need to be done to determine whether the benefit outweighs the risk of taking aspirin. In other words, if you treat 1,000 people with aspirin to prevent colon cancer, are you going to prevent more cancers or are you going to see complications that are more serious? We don’t have that answer yet.
What are the risks of aspirin therapy?
Since aspirin acts as a blood thinner, a person's risk of bleeding is significantly higher while taking aspirin. Oftentimes this simply represents a little extra bleeding or bruising if you cut or bump yourself. However, in the case of a more serious injury, there can be very significant bleeding, which can be life-threatening. Aspirin also increases the risk of developing stomach ulcers, which can also lead to significant and serious complications.
What will you tell your patients who ask you about this new information?
For persons with increased risk of cardiovascular events, aspirin is an important part of an array of treatments that can significantly reduce one's risk of heart attack and stroke. As an added benefit, taking aspirin can also reduce the risk of colon cancer in the same patients.
For the person without significant increased cardiac risk, I will simply state the facts, which are that aspirin can reduce risk of colon cancer, but that we do not know whether this risk-reduction benefit outweighs the risk of complications.