For the first time, an expert panel has recommended aspirin therapy to prevent not only heart attacks but also colorectal cancer.
The guideline for those at high risk of heart disease, published September 14 in a draft report from the US Preventive Services Task Force is the first time a major American medical organization has issued a broad recommendation to take aspirin to prevent a form of cancer. The move follows a growing body of evidence that that aspirin can prevent colorectal cancer.
The Washington Post wrote that the group recommended a daily low-dose aspirin for adults ages 50 to 69 who are at increased risk of cardiovascular disease. It also said aspirin can help reduce cancer risk if taken “for at least 10 years.” The panel added that the benefits of taking aspirin can vary depending on age and health, and that people should consult with a doctor before taking aspirin regularly.
Created in 1984, the US Preventive Services Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine. It makes evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.
The New York Times wrote that the draft guidelines are drawing criticism from some experts who worry that healthy people who take aspirin could develop side effects such as gastric or brain bleeding and hemorrhagic strokes. Others say there are far better proven ways to prevent heart attacks and thwart colon cancer, such as cholesterol-and blood-pressure-lowering drugs to reduce heart risk and screening colonoscopy to identify precancerous polyps.
Nearly 40% of American adults older than 50 years old use aspirin for primary or secondary prevention of cardiovascular disease—a number likely to increase if the recommendations are finalized.
The Post wrote that this stance seems at odds with findings published last year by the Food and Drug Administration (FDA). Already millions of people “take aspirin who shouldn’t,” Steven Nissen (chairman of cardiology at the Cleveland Clinic), told the Times. Nissen was part of a recent FDA review that concluded aspirin should not be used to prevent a first heart attack or stroke.
The FDA denied a request by Bayer in 2014 to change the labeling on aspirin to allow marketing of the product for prevention of heart attacks in patients with no prior history of cardiovascular disease.
“There’s an incredible paradox here,” said Nissen told the Times. “You have 2 different arms of the government [giving] exactly opposite advice.”
Kirsten Bibbins-Domingo, the task force’s vice chairwoman, said the benefits of aspirin therapy were strongest for people who had a history of heart attack. The challenge is weighing the risks and benefits of daily aspirin for healthy adults “who have no other signs and symptoms but have multiple risk factors” for cardiovascular disease, she said.
“These things are what make the decision to take aspirin complex,” Bibbins-Domingo said.
Cardiovascular disease and cancer are the leading causes of death for American adults; colorectal cancer is the third most common cancer in the US, causing about 50,000 deaths last year.
The task force based its recommendations on a series of evidence reviews it commissioned. One review found that aspirin reduced heart attacks by 22% and reduced overall rate of death by 6%, but did not reduce strokes or deaths from cardiovascular causes. Another data analysis found a reduction in strokes.
A separate analysis on colorectal cancer found aspirin use cut colorectal cancer deaths by 33% and reduced colon cancer incidence by 40%. People needed to take aspirin at least 5–10 years for it to have an effect.
A third study found that aspirin use increased stomach bleeds by about two-thirds, and could increase the rare risk for hemorrhagic stroke. The task force noted that more research is needed to determine how aspirin interacts with a number of widely used medications like cholesterol-lowering statins and proton pump inhibitors.
David Johnson, who serves on the US Multi-Society Task Force on Colorectal Cancer, told the that Times he was concerned that patients taking low-dose aspirin would forgo colonoscopies.
“People still need to be screened,” Johnson said. “I have major reservations that the message will be, ‘I take aspirin, so I don’t need to be screened.’ ”
But officials with the American Heart Association (AHA) and the American Cancer Society praised the new recommendation. “The task force did an outstanding job,” Mark Creager (president and chief voluntary scientific and medical officer of the AHA) told the Times, adding the position was consistent with his organization’s guidance.