"In these trials, the reduction of colorectal cancer rates was in essence a side-effect of treatment. None of them had such a reduction as their primary outcome. Nevertheless, the evidence that aspirin is effective for preventing these colorectal cancers is very strong," Prof Benamouzig said.

Arguing that the answer to the question should be “No” is Prof Nadir Arber, Director of the Integrated Cancer Prevention at the Tel Aviv Sourasky Medical Center in Israel.

“NSAIDs and in particular aspirin are very promising in secondary prevention of colorectal neoplasia, however their role in primary prevention is still not proven,” Prof Arber said. “This means that the majority of the population does not need, and is not going to benefit from aspirin use. Having said that, specific high-risk populations definitely can benefit from aspirin intake, including people with hereditary non-polyposis colorectal cancer, familial adenomatous polyposis, existing colorectal cancer or adenoma. In the future based on genomic profile, we would be able to identify people who are at high risk of developing colorectal cancers and who might benefit from aspirin therapy.”

During the discussion, Prof Arber will present preliminary data showing how the efficacy and toxicity of aspirin in preventing cancer can be predicted based on some single nucleotide polymorphisms.

Before aspirin can be used for preventing these cancers, we need to develop means of identifying people who are going to benefit from the drug without developing side-effects, Prof Arber said. Risks of taking aspirin include gastrointestinal bleeding and intracranial hemorrhage. “We need a study that will measure overall morbidity and mortality and not efficacy and toxicity in a single organ or disease such as cardio-vascular disease,” he said. 

Source: ESMO