Abstract
Many studies have evaluated the long-term benefits of aspirin use; however, the association of aspirin use with cancer incidence and survival in older individuals remains uncertain. Additional population-based evidence of this association is necessary to better understand any possible protective effects of aspirin in older adults. To investigate the association of aspirin use with risk of developing new cancers and site-specific cancer-associated survival in bladder, breast, esophageal, gastric, pancreatic, and uterine cancers. This cohort study used data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Participants were aged 65 years or older at baseline (1993-2001) or reached age 65 during follow-up. Data analysis was conducted from January to June 2020. Incidence of and survival from the investigated cancer types. Univariable and multivariable hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazards regression modeling, adjusting for covariates. Multivariable models for incidence included time-varying covariates. A total of 139 896 individuals (mean [SD] age at baseline, 66.4 [2.4] years; 71 884 [51.4%] women; 123 824 [88.5%] non-Hispanic White individuals) were included in the analysis. During the study period, 32 580 incident cancers (1751 [5.4%] bladder, 4552 [14.0%] breast, 332 [1.0%] esophageal, 397 [1.2%] gastric, 878 [2.7%] pancreatic, and 716 [2.2%] uterine cancers) were reported. Aspirin use was not associated with incidence of any of the investigated cancer types among individuals aged 65 years or older. Multivariable regression analysis demonstrated that aspirin use at least 3 times/week was associated with increased survival among patients with bladder (HR, 0.67; 95% CI, 0.51-0.88) and breast (HR, 0.75; 95% CI, 0.59-0.96) cancers but not among those with esophageal, gastric, pancreatic, or uterine cancer. A similar association of any aspirin use with bladder (HR, 0.75; 95% CI, 0.58-0.98) and breast (HR, 0.79; 95% CI, 0.63-0.99) cancer survival was observed. In the current study, any aspirin use and aspirin use at least 3 times/week was associated with improved bladder and breast cancer survival. Associations between aspirin use and incidence of any of the investigated cancers or between aspirin use and esophageal, gastric, pancreatic, or uterine cancer survival were not observed.
Highlights
Aspirin is recommended for primary prevention of cardiovascular disease in individuals aged 50 to 59 years with high risk for that disease, with the additional stated benefit of a reduced risk of colorectal cancer.[1]
Aspirin use was not associated with incidence of any of the investigated cancer types among individuals aged 65 years or older
Multivariable regression analysis demonstrated that aspirin use at least 3 times/week was associated with increased survival among patients with bladder (HR, 0.67; 95% CI, 0.51-0.88) and breast (HR, 0.75; 95% CI, 0.59-0.96) cancers but not among those with esophageal, gastric, pancreatic, or uterine cancer
Summary
Aspirin is recommended for primary prevention of cardiovascular disease in individuals aged 50 to 59 years with high risk for that disease, with the additional stated benefit of a reduced risk of colorectal cancer.[1]. Between 25% and 50% of adults in the United States have reported taking aspirin daily or every other day, with usage increasing with age.[2,3] Long-term aspirin use has been associated with decreased risk of heart disease, stroke, cancer ( gastrointestinal cancers), and all-cause mortality.[1,4,5,6,7] Recent research suggests that aspirin use may offer protection against the development of and mortality from other cancer types as well.[4,7,8] the benefits and harms of taking low-dose aspirin in older individuals is still debated, in light of data from the Aspirin in Reducing Events in the Elderly (ASPREE) study that indicated increased cancerassociated mortality—but not cancer incidence—with long-term aspirin use in individuals aged 65 years or older who were not taking aspirin before study enrollment.[9,10]
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