As you might expect, a big part of my job as an emergency physician is prescribing medications and treatments.
But what you can’t expect is that what I prescribe will change often.
This is all due to the latest available evidence: and whether or not you should take aspirin is a good example.
Until just a couple of months ago, I personally did not take a daily aspirin, nor did I recommend it to patients unless they had specific risk factors, such as a previous heart attack or after a stroke.
This was due to the risk of stomach bleeding: some studies show that a daily dose increases the risk of bleeding by up to 50 percent.
New evidence published in the journal Cancer suggests that the benefits of a 75 mg daily baby aspirin outweigh the risks.
This sounds like a lot, but since only one in every 1,000 patients suffers significant bleeding, it takes 2,000 people taking aspirin for one more patient to suffer. And now there is compelling new evidence, recently published in the journal Cancer, that has convinced me that the benefits of a 75 mg daily baby aspirin outweigh this risk, at least for me.
So now I take it every morning to try to improve my chances of living a longer, healthier life, and I think it’s something you might want to consider too (although be sure to read to the end of this article as there are warnings) . !).
Changing your mind as a doctor is not a sign of not knowing what you are doing, but when new reliable results or theories emerge, our opinions should reflect this.
In fact, in the last lecture I give to our final-year medical students, I implore them to recognize that, while they will no longer be medical students, they should never stop being medical students: since 50 percent of that we have taught will turn out to be wrong; We just don’t know what that 50 percent is yet.
Aspirin is one of the most well-known drugs in the world; It is not only a pain reliever but a wonderful clot-preventing medicine derived from willow bark.
However, over the years that I have worked in the ER, I have seen many patients with terrible stomach bleeds related to taking aspirin: in my opinion, this clearly reinforced the idea that unless someone had a cardiovascular problem specific, such as a previous heart attack, the risks of taking aspirin were greater than the benefits of the clot-preventive properties.
However, new evidence is emerging about the benefits of aspirin, suggesting that it may help prevent some types of cancer, as well as increase your chances of survival if you contract the disease, by a staggering 20 percent.
If you’re wondering why there hasn’t been much news about it, remember that aspirin is very cheap (it’s only a couple of cents per 75 mg tablet), so there’s no incentive for drug companies to promote it.
That’s why aspirin studies are often not the gold standard of expensive randomized controlled trials (where a treatment is compared to a placebo), but rather observational studies (where we look at data from large groups of patients, some of them who take aspirin). .
Therefore, we must analyze these studies in detail. And that’s what a group of statisticians from Cardiff University has done: publish a massive analysis of 118 observational studies (combining the results of more than a million patients with 18 different types of cancer).
The review, published in the British Journal of Cancer in November 2023, showed a 20 percent reduction in deaths from cancer and any type of disease over the course of the studies in people taking aspirin compared to those not taking it. .
And here’s the important thing: The researchers wrote that ‘reasons against using aspirin include an increased risk of gastrointestinal bleeding, although there appears to be no valid evidence that aspirin is responsible for fatal gastrointestinal bleeding…
“In conclusion, given the relative safety and favorable effects of aspirin, its use in cancer appears justified, and the ethical implications of this mean that cancer patients should be informed about the evidence and encouraged to raise the issue with their health care team.
We also now know why aspirin might help, thanks to the new study published in the journal Cancer, which I mentioned at the beginning.
Italian researchers had observed that colon cancer was less likely to metastasize in patients who took aspirin regularly. They investigated and found that aspirin increases the number of tumor-infiltrating lymphocytes (TILs) in cancerous areas.
These TILs are specific parts of the immune system that help fight cancer cells.
This was not due to the anticoagulant properties of aspirin that we all know, but through newly discovered mechanisms: aspirin increased the amounts of a molecule called CD80 in cancer cells. This attracts TILs to the tumor.
Additionally, aspirin increased the number of cytotoxic CD8+ T cells, another powerful tumor-fighting immune cell.
So aspirin is an even more wonderful drug than I thought.
I have now changed the advice I give to cancer patients.
You should consult your doctor about this, but I think the default position should be that if you have cancer, you should take aspirin (75-100 mg).
That is, unless there is a reason not to be (for example, because you are taking a blood thinner for conditions such as heart disease, atrial fibrillation; and when you are over 70, there is an increased risk of bleeding and some evidence that aspirin is not as effective and therefore the benefits versus risks for older cancer patients are not as clear).
What about those with suspected cancer waiting for a diagnosis? Terribly long waiting lists mean that cancer has often spread much further than it should by the time it is finally identified. Aspirin can help slow the spread of cancer and my opinion is that the benefits of a 75 mg dose far outweigh the risks and it is something you should ask your GP about if you or a loved one suffers from it. found in this position.
The good news is that while pharmaceutical companies are not interested in researching aspirin, the charity Cancer Care UK is leading the way, with a trial to see if it can help prevent cancer recurrence.
In the trial, called Add-Aspirin, patients with breast, colon, rectal, gastric and prostate cancer take a placebo, or one of two doses of aspirin (100 mg and 300 mg) for five years: these results will be published in the coming years. .
Aspirin is one of the best-known drugs in the world, not only a painkiller but a wonderful clot-preventing medicine derived from willow bark.
If you are receiving cancer treatment, you can ask your oncologist if you can be included in the trial (it is carried out in hospitals throughout the UK, Ireland and India; in the UK, Coventry and Warwickshire University Hospitals are those who recruit the most).
Simply participating in a trial (regardless of whether the patient is taking a placebo or an active drug) increases the chances of survival through better follow-up and care.
The final question is: can aspirin prevent cancer in the first place?
While the studies are mostly observational, there is some evidence that aspirin reduces the risks of bowel cancer, especially if you have Lynch syndrome, a genetic condition that increases the risks of several types of cancer, including of intestine.
However, a 2018 study showed that if people start taking aspirin starting at age 70, it may increase their risk of cancer.
I plan to continue my new aspirin 75 mg daily until age 70. I am at increased risk of bowel cancer due to a strong family history and have an inflammatory bowel condition, ulcerative colitis, which also increases the risk.
So talk to your doctor about what is appropriate for you; do not self-medicate.
And ultimately, one of the best ways to improve your health is to stay informed and challenge us doctors; We may not know all the latest evidence and need you to ask us so we can give you the best individualized advice possible.
@drobgalloway
