Tuesday, May 06, 2008

Aspirin and breast cancer

I am often asked whether or not I'd recommend the daily use of aspirin. Specifically, with respect to heart disease prevention, 2003 guidelines suggest that those at 10% risk of a heart attack in the next 10 years do just that. Wondering if that's you? Check out Risk assessment tool. Some suggest that the 10% threshold be raised to 15-20% 10 year risk to avoid putting every man over 70 on aspirin due to the risk of bleeding in the GI tract.

Doctors at the National Cancer Institute checked out questionnaires from over 127,000 female AARP member with respect to NSAID usage (aspirin, ibuprofen, and other anti-inflammatory analgesics) and breast cancer incidence over six years(1). While the use of non-aspirin NSAIDs did not affect the risk of breast tumors, the daily use of aspirin dropped the risk of estrogen-receptor positive cancers (the most common type) by 16%.

Just yesterday, a patient asked me if she would experience pain if daily aspirin use was irritating her stomach to the point of bleeding. I have had three patients over 25 years of practice with catastrophic hemorrhages from aspirin use. Two of them started vomiting bright red blood as their first sign of trouble. The third walked into the office on shaky legs, weak and white as a sheet from blood loss over the previous months. He did not realize that black stools were a sign of blood loss through the GI tract. Pepto-Bismol users, don't freak out. PB makes stools black too!

Do I take a daily aspirin? Yes, I do. I've done so every since the Nurses' Health Study results showed that 20+ years of consistent aspirin use, at least 4-6 times per week, cut the risk of colorectal cancer by 46%(2). This study was published in 1995, so I've got 7 years to go to reap my rewards.

Please note, this post is for informational purposes only. Decisions such as daily aspirin use should be made in consultation with your personal physician who is familiar with your health history.
(1)Gierach, G et al. Nonsteroidal anti-inflammatory drugs and breast cancer risk in the National Institutes of Health-AARP Diet and Health Study. Breast Cancer Res. 2008 Apr 30;10(2):R38 [Epub ahead of print].
(2)Giovannucci, E et al. Aspirin and the risk of colorectal cancer in women. N Engl J Med. 1995 Sep 7;333(10):609-14.


JeanMac said...

We each use a daily aspirin - his, on the advice of his MD. I just take it on my own - wasn't advised to.

Ruth said...

I didn't realize the link with breast cancer. Is the coated baby aspirin size still the recommended dose? Perhaps you don't give information that specific on your blog. I should look up the articles.