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Aspirin, cancer risk and a personal decision

Fergus Walsh | 00:00 UK time, Tuesday, 7 December 2010

From now on I am going to take a daily low-dose aspirin. I intend to continue doing this for the next 25 years. It's a decision which every middle-aged person in Britain is going to have to consider in the light of research suggesting that aspirin significantly cuts the death rate from many common cancers.

You can read my report on the Lancet study and an abstract of the research paper.

I cannot say for sure that I am doing the right thing. If I get an intestinal bleed in a few months time and am taken to hospital needing a blood transfusion, then it will be easy to argue that I got it wrong.

That sort of adverse drug incident, for which aspirin is a known risk factor, is easy to track. The absence of disease is a more subtle effect, because who can say for sure why some people get cancer and others do not?

It is the new research showing aspirin's apparently protective effect against cancer which has persuaded me. This, I must stress, is a personal decision.

As a 49-year-old in reasonable health with no obvious signs of cardiovascular disease, I've made my own choice. I think it would be dishonest of me to write a long article about this issue and then fail to answer the obvious question - are you going to take aspirin? But I am certainly not trying to encourage anyone else to follow my example.

The Lancet paper

In the Lancet paper researchers, from Oxford University, Edinburgh, Dundee, London and Japan analysed eight trials, some dating back to the 1970s, which had allocated volunteers to daily aspirin or a dummy pill. The original trials were looking at cardiovascular disease, and the data on cancer had never been fully investigated or published.

By dusting down the data and then following up many of the patients health records, the researchers came up with some remarkable results. Those allocated aspirin for between four and eight years had about a 25% lower risk of dying from cancer. This protective effect continued long after the trials had ended. Indeed, after 20 years, their overall risk dying from cancer was still 20% lower than the placebo group.

The research was led by Professor Peter Rothwell, a clinical neurologist at Oxford University, who two months ago published a study which found that a daily low dose of aspirin cut cases of bowel cancer by a quarter and deaths by more than a third.

How aspirin affects cancer

The mechanism by which aspirin appears to protect the body against cancer is not clear. But Professor Rothwell said laboratory tests suggested aspirin intervenes at a very early stage to prevent cancers developing.

He said: "When cells divide there is a chance that the DNA in the daughter cells will be faulty. The body has an mechanism whereby either the faulty cells commit suicide (known as apoptosis) or they self-repair. Aspirin appears to enhance the suicide or the repair."

Conflicting research

The trouble is, that there has been lots of conflicting research about the risks and benefits of taking aspirin.

We already know that aspirin can protect those at increased risk of heart attack and stroke. But for healthy adults without a history of cardiovascular disease, the benefits are very small and seem cancelled out by the increased risks of bleeding from the stomach and gut.

The last report I did on aspirin, in 2008 was about a study in the British Medical Journal. It looked at 1300 adults in Scotland with diabetes who had no previous symptoms of heart disease. It found that aspirin had no protective cardiovascular effect. The study authors said the research added to evidence that aspirin should not be routinely used for patients at higher of heart attack and stroke unless they already had symptoms of disease.

In the past two years, many GPs have been taking healthy middle-aged patients off aspirin.

A game changer?

The question now is, do the findings on cancer change things? Professor Rothwell said it would be helpful if new guidance was issued in the light of the new findings. There are guidelines from the American Heart Association and the European Society of Cardiology, but these pre-date the cancer research. NICE may also decide to review the role of aspirin. The tablets themselves cost just a few pence.

Professor Rothwell did not go so far as to urge people to take aspirin, but he said the evidence was beginning to look compelling. He said people might want to consider taking low-dose daily aspirin (75 mg) from the ages of 45-70 or 50-75. After the age of about 75 the benefits of aspirin were likely to fall away, whereas the risk of gastric bleeding rose considerably.

Another expert on the effects of aspirin, Professor Peter Elwood, from Cardiff University, said people should make the decision themselves as to whether to take aspirin. "It is up to the man in the street to weigh up the risks of getting cancer, having a heart attack or stroke and setting that against the risk of being rushed to hospital with internal bleeding". But he added the risks of dying from a gastric bleed were "small".

Professor Elwood, an epidemiologist, who did some of the first research into the effects of aspirin on heart attack and stroke, said doctors were good at treating disease, but when it came to preventing ill-health then people had to make their own judgements.

But that is hardly an easy decision for people to make. Very few will have time to read the latest research, let alone weigh it against other studies. At some point the medical profession will need to come to a considered view and issue guidance.

Cancer Research UK suggested that anyone considering taking aspirin every day should talk first to their GP. I'm not sure that family doctors will welcome being inundated with requests for a consultation on this topic, but I suppose patients could mention it if they are at their GP for something else.

Professor Alastair Watson, an expert in translational medicine at the University of East Anglia, also urged people wishing to take aspirin to discuss it with their GP. Nonetheless, he added that the research was "further proof that aspirin is, by a long way, the most amazing drug in the world."

Peter Sever, Professor of Clinical Pharmacology and Therapeutics at Imperial College London, agreed that the research was exciting, but he said it was still not possible to decide whether daily aspirin use was advisable for those without cardiovascular disease.

He said: "We have to remember that aspirin is not a safe drug and it causes harm. And until such time as we know what the numbers are - how many cancers are prevented against how many people suffer significant bleeding then we cannot answer that question."

There will be many who will label aspirin a wonder drug, but the Lancet research raises several issues. For example, we do not know what the effect of very long-term use of aspirin might be.

Professor Rothwell said: "There might be some unexpected hazard from taking aspirin over many years, still yet to be discovered".

We also don't have sufficient evidence for the effects of aspirin on the incidence of breast or ovarian cancer, but this should emerge in the next few years.

For the record, Professors Rothwell and Elwood both take aspirin every day. Elwood has been doing this since the mid-70s, whereas Rothwell, who is 46, has been taking aspirin for two years.

Professor Elwood said taking aspirin at night, with calcium, appeared to enhance its effects. Since milk is a good source of calcium and can reduce stomach irritation, he suggested some new trials should test the effects of taking aspirin with a glass of milk.

Of course, it is perfectly possible that some new study will change things yet again. But for now, aspirin and a glass of milk will be part of my evening routine.

Comments

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  • 1. At 01:29am on 07 Dec 2010, Grey Animal wrote:

    It does seem like a small risk to set against what could be a rather substantial benefit.

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  • 2. At 03:12am on 07 Dec 2010, asmac wrote:

    Caution is called for. I took an aspirin a day for a couple of years -- what harm could an aspirin do? -- until I ended up in an emergency room on New Year's Day, 2000. Three units of blood, countless units of saline and a few days later I was able to go home. I was 46 and it was a very close call. The risk of aspirin-caused internal bleeding is real and should not be ignored.

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  • 3. At 03:55am on 07 Dec 2010, A Carden wrote:

    I heard about the benefits against cancer & cardiovascular issues 15 years ago. I have maintained a regular, small, daily intake of aspirin since then. I have to satisfy a medical examination for my profession every three years. I am 48 years old now and my doctor states that I am in good health although, he tells me;- I am above the preferred Body weight for my height & Build etc., and despite the fact that I drink a little more red wine than I should; and also, smoke 20 a-day; and work in a well documented, stressful occupation, My doctor tells me I have fine & healthy heart, lungs & cardiovascular system as was recently confirmed after a hospital scan. (my doctor was concerned 3 years ago about what turned-out to be only a stress related issue which was easily resolved without medication, just adjustment to working practice's).

    I am pleased that research now shows the benefits of Aspirin as I also, am convinced of its Guardian Qualities. I should comment that I am lucky to be signed to my particular doctor as he was the only doctor ( despite the head gyno for the South West Of England's Failure), to identify my wife's problems 16 years ago which, with his help & four years of treatment were resolved. My doctor knows illness when he sees it & medicine. I trust his diagnosis! If he says I am healthy I say;- It is thanks to Aspirin!

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  • 4. At 05:04am on 07 Dec 2010, Brian R wrote:

    I have had two strokes and two Heart Attacks { last combined stroke/heart attack was in 2006 } and currently being treated for Prostate Cancer so have more Consultants than you can shake a stick at.

    Consultants are very wishy-washy over this subject and no one has advised me it would be sensible ' for me ' to take a small daily dose of aspirin so really I am very skeptical over the whole subject.

    I have met Cancer patients who sadly died during treatment.

    Funny enough it was due to my health history why Prostate Cancer was discovered so quickly as I get annual blood tests so treatment started before any symptoms kicked in - the patients I met who died all started treatment after symptoms developed so a early diagnosis is crucial in most cases.

    I am sure for many Healthy people it may be a sensible precaution I just wonder how many Consultants are going to hand out the same advice to their current Cancer patients as they are certainly not doing it just now.

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  • 5. At 08:05am on 07 Dec 2010, Megan wrote:

    Yet again, statistics rather than science!

    When medicine can tell me WHY asprin is good at preventing cancer I'll listen. Until then, they're just rolling dice.

    Taking a set of percentage dice to the GP's surgery can be amusing... most don't even understand probablility, despite talking about 'risks' as if they had empirical scientific validity, with cause and effect understood.

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  • 6. At 08:35am on 07 Dec 2010, Dave wrote:

    Isn't this story a bit dangerous without stating the dosage? I understand the dosage for this type of daily preventative method is only 75mg, which is a quarter of the standard dose taken to relieve pain.
    What happens if people read your article and start taking a single standard 150mg tablet each day? Increased risk of internal bleeding?

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  • 7. At 08:47am on 07 Dec 2010, louise wrote:

    I use to take aspirin daily due to have AF and a family history of heart disease, but i was always worried about internal bleeding and other side effects of taking a drug long term. I spent a lot of time looking on the internet and the only alternative to aspirin that I could find was the Sirco drink with the fruitflow ingredient- which has been proven to work and its all natural ingredients, so now i drink that daily and artichoke extract(reduces choloesterol)all bought from the health food shop and amazon. Im not sure if id take aspirin again, until there is a lot of research and real evidence, one minute its bad for you, the next its a preventative for cancer?

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  • 8. At 08:54am on 07 Dec 2010, scintillate wrote:

    Because my family has a poor history of heart disease I have taken aspirin for a number of years. There is no way of knowing at this stage whether it has afforded me any cardiovascular protection but it certainly did not stop me from getting aggressive prostate cancer. I have also had two intestinal bleeds in the past three years although I was also taking fish oil (another blood thinner) at the time which may have been a contributory factor.

    I don't think anyone should be carried away by the "percentage benefits" attributed to aspirin by the "experts" and people should certainly proceed with caution since aspirin can definitely cause bleeding in the stomach and, I believe, in the brain.

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  • 9. At 09:01am on 07 Dec 2010, mister_benn wrote:

    Dave is spot on.
    If you want to take aspirin on the strength of this item, PLEASE be careful about dose. The protective dose mentioned in the article is 75 mg per day. That is just a quarter of one standard painkilling dose.
    People who rush out and take a couple of tablets a day to protect against cancer are doing themselves more harm than good. There are real risks from this drug -- the very low dose described in this study will minimise those risks.

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  • 10. At 09:01am on 07 Dec 2010, Derek wrote:

    With regard to the stomach bleed problem, is it known what is causing the bleed? I wonder if soluble aspirin would be better in this respect, either because there would be no physical irritation, as there may be with a tablet, or because it would pass through the stomach more quickly. Any ideas?

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  • 11. At 09:03am on 07 Dec 2010, canygwynt wrote:

    The change in relative risk sounds large, but what's the reference point? If the actual risk of dying of the exprimental subjects of dying from cancer without aspirin were one in a hundred a reduction of 25% would make it 0.75 in a hundred. I expect it's more than that, but how much more? The medical habit of talking only of relative risks obscures reality. Must ask the Radio 4 statistics programme to find out how big the numbers really are.

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  • 12. At 09:19am on 07 Dec 2010, Derek wrote:

    A thought about the dose question. We read that it is 75mg. But shouldn’t the dose vary according to the size of the individual – I would have thought it strange to have the same dose for someone that is less than 5 feet tall & weighing 7 stones, and someone that is 6 feet 6 inches tall & weighing 20 stones. Would the small person be getting too much and the large person getting too little?

    I must admit this is a question I have about most medicines, that seem to base dosage on humans coming in just two sizes – child & adult.

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  • 13. At 09:24am on 07 Dec 2010, betuli wrote:

    I am male, 44, in reasonably good health, pondering to take the 75 mg per day aspirin dose. However the small possibility of internal bleeding refrains me from starting.

    My question is whether there are any symptoms predicting an internal bleeding or it comes suddenly. Also is it dangerous or life-threatening? I would very pleased if someone could answer these questions. Many thanks.

    BTW, Fergus, I think it is a good idea to put yourself as an example of a personal decision. Well done!

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  • 14. At 09:33am on 07 Dec 2010, Neil Martin wrote:

    This comment was removed because the moderators found it broke the House Rules.

  • 15. At 09:43am on 07 Dec 2010, Alan Hammond wrote:

    When will they make up their MKNDS about Asprin
    First they say that one a day is good for you
    Then thay say it is NOT good for you and one should stop taking it
    And NOW again they are saying it is Good for you
    I was told NOT to take it and that STILL stands as far as I am concerned

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  • 16. At 10:06am on 07 Dec 2010, peter s wrote:

    I had a phase of taking 75mg aspirin but got annoyed that the only tablet available was packaged for children and for some reason the drug companies felt that that meant they could charge soemthing like 8 times as much. Is there yet a 75mg dose for adults that is sold at a fair price?

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  • 17. At 10:08am on 07 Dec 2010, cheggersplayspop wrote:


    If there is concern at internal bleeding on a one-a-day dose, is there any benefit in going one every other day?

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  • 18. At 10:15am on 07 Dec 2010, Brian wrote:

    The article was reading well until the closing comments on milk.

    The China Study by Prof Colin Campbell has been described as “the grand prix of nutritional epidemiology” and should be read carefully before considering consumption of any dairy product. This is because laboratory trials reported in the book have shown that cancer can be turned on or off by respectively including or excluding animal fat.

    What fuels us has important longevity implications.

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  • 19. At 10:17am on 07 Dec 2010, TyneBlade wrote:

    In a small number of people (I am one of them), it is well recognised that aspirin can precipitate an asthma attack. I have not had an asthma attack in the 6 years since I discovered this and stopped taking aspirin.

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  • 20. At 10:35am on 07 Dec 2010, The doc wrote:

    re 10 (Derek.)

    Good question - but unfortunately the stomach ulcers that aspirin causes (subsequently causing bleeds) are not secondary to local irritation but are inherent in the biochemical pathways by which the drug has its effect.

    Thats why most places don't use enteric coated capsules / liquid preparations.

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  • 21. At 11:17am on 07 Dec 2010, Baz wrote:

    I am approaching 61 years of age and have been taking ompremazole and it's predecessors for the last 25 years as I produce too much acid. I was advised by my doctor ( at the time of diagnosis) that I should NOT take asprin or it's derivatives ( including ibuprofen etc) as the result could be catastrophic. So how does someone in my position take action to prevent such problems. As an aside I used to teach weight training ( part time) and have always kept physically fit.

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  • 22. At 12:02pm on 07 Dec 2010, CPslashM wrote:

    The chances of having a bleed are about the same as having a heart attack. The chance of dying from your first heart attack is 40%. If you survive you are likely to be disabled to a certain extent. The chance of dying from a bleed is about 4%. If you survive you should make a complete recovery.

    There are various factors affecting the chances of bleeding - e.g. heliobacter pylori (a type of bacteria) in the stomach increases the risk fourfold. Of course, having an ulcer doesn't help, either. Apple polyphenols appear to reduce the risk of bleeding in rats. Early days.

    If a cell divides and there are errors in the DNA, the cell may repair itself, destroy itself or become cancerous. Laboratory studies are limited in that they do not take into account everything that is going on. However, in the test tube, aspirin appears to enhance the repairing or self-destruct mechanisms. This means that cancer can be nipped in the bud if aspirin is taken daily, but this won't be noticeable until perhaps several years later when the cancer becomes apparent.

    Plants produce salicylates (the anti-cancer part in aspirin) only when they are under stress. Modern agriculture prevents stress in plants (removing water or temperature stress and pest attack) resulting in many foods with no salicylates at all.

    Perhaps we should have an organic apple a day to keep the doctor away...

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  • 23. At 12:04pm on 07 Dec 2010, mung1973 wrote:

    interesting that the mechanism is thought to be self-sacrifice of damaged cells. most vegetable plants USED TO contain much higher amounts of salicylic acid (from which aspirin is derived) than they do now, because they used to need greater self-sacrifice defence mechanisms themselves (from insect attack, getting bashed about, etc). modern spraying and breeding techniques have reduced vegetables need for salicylates - but not ours, perhaps? so eating organic and/or traditional heritage varities of fruit and veg, might be an alternative to pill popping, in terms of cancer prevention.

    also interesting that the benefit seems mainly to be in the digestive tract. another natural alternative to aspirin worth investigating (in consultation with a properly qualified herbalist, ie one registered with NIHM) is meadowsweet - the plant from which salicylic acid was first identified (it's latin name used to be 'spirea', hence 'a-spirin'). meadowsweet is used by herbalists to ease inflammation and pain (esp in the joints and digestive tract) but also its used for TREATING stomach ulcers, heartburn, etc, due to its other ingredients such as mucilage, which soothe and tone the digestive tract and stop stomach acid reaching and damaging the sensitive mucus membranes. an example of the synergistic effects of using whole herbs, compared to one islated principle.

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  • 24. At 12:20pm on 07 Dec 2010, adamcollyer wrote:

    Just to correct some of the comments about dose: the protective dose being talked about is indeed 75 mg, which is one quarter of one standard aspirin tablet, or one eighth of the normal pain-killing dose. A standard aspirin tablet is 300 mg not 150 mg.

    I noticed that you can now also buy 75 mg low-dose aspirin tablets in the local supermarket, which obviously makes taking this dose easier. The ones I saw were enteric coated as well, which should reduce risks to the stomach lining.

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  • 25. At 2:18pm on 07 Dec 2010, Alice wrote:

    In this study, there was a 25% relative risk reduction, but this gives (from my calculation) an absolute reduction of 0.7% deaths, which isn't anywhere near as dramatic as the headlines suggest. The time spans are also really long, so taking these effects 'per year' will make the numbers even less impressive.

    On the cardiovascular front, aspirin has been shown to be helpful in patients who have already had a stroke, heartattack etc. Current advice is not to use it to try to prevent cardiovascular events, as you have to treat too many people to aviod one event, to make it worthwhile the risk of bleeding.

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  • 26. At 5:55pm on 07 Dec 2010, sensiblegrannie wrote:

    Asprin is one of those medications that has gone through fashion phases. I believe it is no longer recommended for children whereas it was a standard painkiller years ago. I always used asprin even when it lost popularity because it was remarkably quick in sorting out a bout of rheumatism.

    In the past, I had to deal with the frightening effects of internal bleeding (of some of the patients I looked after during my nursing days). Internal bleeding is one risk of asprin. It would be advisable to find out all of the risks and contraindications of asprin before making a decision to take it daily. However, many over-the-counter drugs have side effects that you might not have considered. Even certain herbal remedies can interfere with the effects of other medications and so it is always best to check out everything.

    However, weighing up the risk factors, I would still be willing to take a small daily dose of asprin if it reduced the chance of a cancer developing. The enteric coated asprins cost more but they reduce the chances of developing an irritated stomach lining.

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  • 27. At 7:24pm on 07 Dec 2010, Ivan wrote:

    I used to listen to the Jimmy Young Show on the BBC most lunchtimes on my car radio back in the 70s and 80s. One particular day, probably around 1980, Jimmy had on as usual his resident doctor who's name escapes me. He was talking about the benefits of taking aspirin. Ever since that day I have taken 75mg of aspirin and never missed a day. For all of that time I have bought ordinary dispersible aspirin at around a penny per tablet (now) and broken them into 4 pieces. I would be about 37 years of age when I started taking it and now, at 67, my wife thinks I should stop. After reading this latest information, I think she's probably right in that the benefits (if any) are now achieved. I have enjoyed good health apart from pancreatitis 4 years ago, which is now cured. I cannot say definitively whether it has helped me or not but I reckon it probably has.

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  • 28. At 01:17am on 08 Dec 2010, Farmer_Oak wrote:

    I am on a daily dose of asprin prescribed by my GP but I have heard that there is a safe alternative called Fruitflow developed by Aberdeen University that has recently been approved by the European Food Safety Authority (EFSA)

    Unlike aspirin Fruitflow doesn't cause bleeding and also prevents deep vein thrombosis so why is it not available on the NHS?

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  • 29. At 08:59am on 08 Dec 2010, William Stevenson wrote:

    #3 above says: "I am 48 years old now and my doctor states that I am in good health although, he tells me;- I am above the preferred Body weight for my height & Build etc., and despite the fact that I drink a little more red wine than I should; and also, smoke 20 a-day; and work in a well documented, stressful occupation, My doctor tells me I have fine & healthy heart, lungs & cardiovascular system as was recently confirmed after a hospital scan."

    This illustrates the difficulty with population health advice. This man appears to believe that he has a fine and healthy heart and lungs when he hasn't, and that aspirin will counterract the effects of smoking, lack of exercise and being overweight, which it won't.

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  • 30. At 09:41am on 08 Dec 2010, Mack wrote:

    Having looked at all of this and spoken with my GP, I have decided to take low dose aspirin. I reached the personal conclusion that the expected benefits massively outweigh the much smaller risk of a stomach bleed, which, if it were to occur, is far less life threatning than heart attack, stroke or cancer. Junior Aspirin was suggested by my GP, which is exactly 75mg, the recommended dose. I bought a bottle of 100 from my local Sainsbury's for 87p, well under 1p a day!

    Funny, but I can't help thinking that if a product was advertised on TV that reduced the risk of cancer, stroke and heart attack as much as is claimed for aspirin, we'd all be queuing up for it and happy to pay a whole load more than the £3.17 a year it'll cost for my daily aspirin!

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  • 31. At 09:12am on 09 Dec 2010, webhoover wrote:

    This sounds a sensible aproach, to minimise the impact on the stomach i dissolve a dispirsible 75mg asprin (300mg split into 4, simples) in 2 liters of water and consume throught the day

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  • 32. At 09:14am on 12 Dec 2010, junior wrote:

    What member of the biomedical profession (I am as well ) was responsible for suggesting that the anti-neoplastic effects of aspirin are due to enhanced apoptosis or DNA repair? Are they out of touch with current thinking ? Aspirin is an anti-inflammatory agent,so look no further! And there is sufficient evidence in the Medical literature (that your correspondent should be aware of )on the enhancement of tumour progression by the innate ( NOT ADAPTIVE ) immune response.Look no further Fergus!Or give me your job for a week (only )

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  • 33. At 09:20am on 12 Dec 2010, Swifty wrote:

    I'm waiting to see the informed comments from those who have died from Aspirin or cancer.

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  • 34. At 11:57am on 12 Dec 2010, John Ellis wrote:

    junior this article is funny much like the alzheimer's protein one.

    as far as im aware aspirin accelerates the interactions of the endocannabinoid system network and helps produce cannabinoid compounds (lipids) that fix the helix in the dna string.
    now we come to alzheimer's. damn more cannabinoid interactions.
    http://www.biomedsearch.com/nih/Endocannabinoids-prevent-beta-amyloid-mediated/20923768.html

    fergus were in the 21st century now :)

    They still claim its okay to drink alcohol and that alcohol does not pass through mum to baby... pity they didn't look at the ECSN when they publicised this data.

    seems it just drug and alcohol lobbying by the news.

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  • 35. At 12:38pm on 12 Dec 2010, John Ellis wrote:

    Some really light reading from a fantastic mind in 21st century Biology.

    http://www.uccs.edu/~rmelamed/dna_repair_and_mutagenesis_.html

    http://www.uccs.edu/~rmelamed/endocannabinoids_and_medica.html

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  • 36. At 8:18pm on 12 Dec 2010, Robin Davies wrote:

    I will not be taking asprin because the science is far from settled and at 68 I can see no virtue but some harm.
    At the end of the report, mention is made of milk being a good source of calcium. It's a source, but there are better. The type of milk you use markedly affects the body's intake of calcium from milk. If you drink whole milk (full cream/fat) the body absorbs 50% of the calcium. If you drink semi-skimmed, the absorbtion rate is 25% and with skimmed milk the absorbtion rate is only 5%. Remember that milk is 95% water.

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  • 37. At 8:23pm on 12 Dec 2010, John Ellis wrote:

    http://content.onlinejacc.org/cgi/content/abstract/56/25/2115

    this be interesting as well CBD's prevent heart complications in type 1 diabetes.

    The future is not looking to Rosy for big pharma at all.

    PRE-CLINICAL RESEARCH
    Cannabidiol Attenuates Cardiac Dysfunction, Oxidative Stress, Fibrosis, and Inflammatory and Cell Death Signaling Pathways in Diabetic Cardiomyopathy

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  • 38. At 9:30pm on 12 Dec 2010, crabsallover wrote:

    Jack Cuzick et al (Lancet Oncol 2009; 10: 501–07, table 2) show that a 20 year daily dose of aspirin could result in up to 20% of people having either serious gastrointestinal bleed, gastric/duodenal ulcer, occlusive or haemorrhagic stroke. These risks, in my opinion, are more than offset by the 20% reduction in cancer reported by Peter Rothwell et al (The Lancet, 7 December 2010).

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  • 39. At 10:24am on 14 Dec 2010, tony wrote:

    There is no such thing as a miracle drug. The effects of a healthy diet, exercise, limiting drinking and not smoking far outweight the benefits of any drug. But most of us don't do all the above very well (including myself), hence the need to offset the effects with something like aspirin as it's an easy (lazy) option.

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  • 40. At 10:25pm on 14 Dec 2010, rwilson999 wrote:

    The discussion on Aspirin fails to mention an important fact - you should use enteric coated baby aspirin. This will reduce the aspirin affect on the stomach.

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  • 41. At 00:13am on 15 Dec 2010, L A Odicean wrote:

    My advice is, at an early age, get yourself some good quality genes.

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  • 42. At 08:24am on 15 Dec 2010, soccerhawkins120131 wrote:

    I'm regarded by medics as being quite wicked...I had to work at a very active job with sciatica and then arthritis...when I consulted a doc, all I got was "Old age dear" So I used my expensively gained pharmacuetical knowledge and started taking soluble aspirin, 1000 mg a day. I was able to continue working until retirement, and am still reasonably active. I can bear a bit of pain in the day time, but when I want to sleep through the pain, I take the aspirin. There is a risk of an internal bleed....I would rather die quickly fron that than live to have to endure the ministrations of nursing home care workers...ex-nurse and pharmaceutics student

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  • 43. At 6:47pm on 15 Dec 2010, John Ellis wrote:

    Sorry to invade your discussion again but I think you'll find this article on cancer really good, pity it will never make health news on the BBC. After all it has no medical value in the UK.
    http://www.molecular-cancer.com/content/9/1/196

    Abstract
    Background
    ErbB2-positive breast cancer is characterized by highly aggressive phenotypes and reduced responsiveness to standard therapies. Although specific ErbB2-targeted therapies have been designed, only a small percentage of patients respond to these treatments and most of them eventually relapse. The existence of this population of particularly aggressive and non-responding or relapsing patients urges the search for novel therapies. The purpose of this study was to determine whether cannabinoids might constitute a new therapeutic tool for the treatment of ErbB2-positive breast tumors. We analyzed their antitumor potential in a well established and clinically relevant model of ErbB2-driven metastatic breast cancer: the MMTV-neu mouse. We also analyzed the expression of cannabinoid targets in a series of 87 human breast tumors.

    Results
    Our results show that both Δ9-tetrahydrocannabinol, the most abundant and potent cannabinoid in marijuana, and JWH-133, a non-psychotropic CB2 receptor-selective agonist, reduce tumor growth, tumor number, and the amount/severity of lung metastases in MMTV-neu mice. Histological analyses of the tumors revealed that cannabinoids inhibit cancer cell proliferation, induce cancer cell apoptosis, and impair tumor angiogenesis. Cannabinoid antitumor action relies, at least partially, on the inhibition of the pro-tumorigenic Akt pathway. We also found that 91% of ErbB2-positive tumors express the non-psychotropic cannabinoid receptor CB2.

    Conclusions
    Taken together, these results provide a strong preclinical evidence for the use of cannabinoid-based therapies for the management of ErbB2-positive breast cancer.

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  • 44. At 11:56pm on 17 Dec 2010, crabsallover wrote:

    Peter Rothwell & colleagues (The Lancet 7th December 2010) say the 8 randomly controlled trials show that cancer fatalities are reduced by 20% with daily 75mg aspirin. After accounting for fatal stomach ulcers, bleeding and strokes caused by aspirin the net benefit of aspirin is about a 10% reduction in all-cause mortality.

    Rothwell has told me that "The Odds Ratio (OR) for all cause mortality in the trials was 0.92 (see paper). Excluding patients who were randomised but stopped treatment before the first follow-up it was 0.88 in those trials with the data available. So "about 10%" seemed reasonable."

    I calculate that if all the UK population started taking daily aspirin between 45 & 70yrs, 3900 lives each year could be saved.

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  • 45. At 07:11am on 23 Dec 2010, Elina Joshef wrote:

    This comment was removed because the moderators found it broke the House Rules.

  • 46. At 07:26am on 23 Dec 2010, Elina Joshef wrote:

    I have found this blog very interesting. It’s a beautifully written blog. The blog has gathered and arranged information in a brilliant fashion. The people who are interested in this field will like your article very much.

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  • 47. At 1:12pm on 24 Dec 2010, Kadazan wrote:

    It's about time the medical professions got their act into gear. Many years ago, Aspirin BP was as popular as Smarties and probably taken just as frequently! Then along came the warning about stomach ulceration and internal bleeding with the severe warning not to take Aspirin unless under medical supervision. Fine one thinks but it was never taken off the shelves. Now we are being told that in certain cases, it helps to prevent cancer. Sorry, the damage has already been done, I for one am not about to start taking Aspirin under any circumstances. I could cite Codeine and DF118 as more examples of confusing messages from the medical profession but I'll leave that for another day!

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  • 48. At 09:54am on 27 Dec 2010, RamachandraWani wrote:

    Aspirin seems to be most popular prescription for various diseases. It is a risk for patients if it is taken at large amount. Breast cancer is not possible by taking aspirin only. Thre are hundreds of reasons behind breast cancer. It is more common to take regular Aspirin to fever without any panic. Today, alternative medicines are sold out to compete with Allopathy. Some medicines may be beneficial but they are hazardous if taken in large amount. Ayurveda is also a side effecting system of medicines. No any doctor has fuul knowledge of the plants having medicineal content. We have to trust in Western medicine only.

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  • 49. At 4:10pm on 17 Jan 2011, sweetice wrote:

    Thanks to the statistics-oriented posts--they really help in interpreting the evidence. Here are a couple of additionals points (non-statistical).

    The "original aspirin" found in plants, salicylic acid, is highly irritating to the stomach. The aspirin we buy, acetyl salicylic acid, is much less so, which is why we switched as soon as the alternative is available. My guess is that high levels of salicylic acid in some plants (bark) is an anti-herbivore scheme, working because of the high irritation levels it causes. (Salicylic acid in plants has other roles that only require low concentrations and don't relate to humans.)

    The formation of cancer has long been recognized to be associated with inflammation, and aspirin is an anti-inflammatory compound, in addition to any other modes of action preventing cancer. Fruitflow has been shown to affect red blood cells, not cancer cells, so there is no reason to think it is going to reduce cancer rates. Aspirin affects blood in a different way from Fruitflow, as well as doing other things.

    I'm still undecided as to whether to take the daily aspirin. Maybe I'll only do it when I'm close to modern medical care (which I'm often not), and just for the next 10 years or so. I've always been concerned about bleeding to death unecessarily in a car crash. We all have to include our own circumstances and fears when making such a decision where the risks and benefits are statistical in nature.

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  • 50. At 05:04am on 28 Oct 2011, Mucky wrote:

    Why are the BBC pushing Aspirin again? (another article Oct 28th 2011)

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  • 51. At 07:29am on 28 Oct 2011, tessapick wrote:

    Aspirin, in some form such as willow bark is a very old remedy, humans have used it for centuries. It is a better antipyretic than paracetamol, is less likely to be harmful in overdose than paracetamol which can cause fatal liver damage, and yet, strangely has had such a bad press since the early '80's that many people I know would never use it. Selling such a cheap and relatively harmless drug in 16's makes it far more expensive than it used to be, and annoys me greatly as it is, and always has been my painkiller of choice, and along with a daily 1000mg effervescent vit C has been my family's main preventive healthcare for nearly 40 years - no complaints so far....

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  • 52. At 08:20am on 28 Oct 2011, Robin Davies wrote:

    You mention towards the end of your piece that "milk is a good source of calcium".
    This is not really true. The absorption rate for the calcium in milk can be below 25%, especially if you drink skimmed or semi-skimmed milk. The body simply excretes the rest of the small amount of calcium that there is in milk - remembering that milk is 95% water. The best source of calcium is probably vegetables. Calcium absorption from milk is governed by the amount of Vitamin D in your body. As most of the population in the Northern Hemisphere is Vitamin D deficient, that's a problem.

    This study does not give me any confidence at all about taking a daily aspirin. The proven side effects are too bad for it to be a sensible decision.

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  • 53. At 08:34am on 28 Oct 2011, aisebon wrote:

    At low doses (SEVENTY-FIVE MILLIGRAMS, 75mg: DO NOT TAKE 300mg EVERY DAY), aspirin mainly acts to reduce the likelihood of blood clotting. This is why it reduces the risk of heart attacks and strokes (many strokes and heart attacks are due to blood clots).

    However the drug action also causes the stomach to become more acidic and irritated, and for any bleeding to become prolonged. This effect is not reduced if you buy a coated tablet, or buy dispersible aspirin, as it's the drug effect from the blood and not an effect from the drug being in the stomach.

    Think on this: we know how aspirin harms you. We don't really know how it heals you when it comes to cancer. Therefore we have to rely solely on slightly dodgy statistical studies.

    There's a reason why medical professionals are nervous about prophylactic aspirin. The evidence is only conclusive in reducing death rates in those who've already suffered a heart attack. As a preventative measure in anyone else, it's just not clear whether the risks outweigh the benefits.

    Furthermore, if you have no known risk of the "thromboembolic" type of stroke/heart attack, you may actually increase your risk of stroke, and your likelihood of dying from it, as it could cause a bleed in the brain that simply wont stop.

    Your best best is to see a doctor (or two) and ask them to assess what your cardiovascular risk is.

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  • 54. At 08:38am on 28 Oct 2011, Jason Twell wrote:

    I was first prescribed Aspirin around 2000 when I started suffering from Angina. At first the dose was 75mg but when the Angina got worse (prior to my triple heart bypass operation) I voluntarily upped the dose to 300 mg. In recent years I started to suffer from Intermittent Claudication (mainly in the right calf) so I continued taking 300mg of Aspirin.

    I dissolve 4 x 75mg tablets in my mouth at night, prior to taking my last drink of the day (beverage!, the rationale being that one sweats at night which thickens the blood and as one is asleep you can't offset this by drinking fluids so the Aspirin acts as an anti-coagulant.

    I have never suffered from any stomach discomfort (presumably because the tablets are thoroughly dissolved first and enter my stomach as a liquid). I also do a lot of DIY which invariably causes me to suffer many minor accidents like cuts and bruises and these seem to heal very quickly - so I don't consider myself to be a "bleeder".

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  • 55. At 09:22am on 28 Oct 2011, peter robinson wrote:

    Really interesting blog and responses, but frustrating the number of responses along the lines of 'aspirin: first its OK, then its not, now it is...when will they get their act together?'Science proceeds thro' time, its results are often unpredictable. The development of understanding is never a straight line.
    I do think the use of 'percentage risks' should be banned.Many people do not understand percentages (which is why credit card companies make money!).Better to use actual numbers of expected deaths under different treatment regimes. In the final analysis we are all genetically different so our response to any treatment regime will always require a gamble with a possible negative outcome.

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  • 56. At 09:10am on 30 Oct 2011, John Bryson wrote:

    This comment has been referred for further consideration. Explain

  • 57. At 09:52am on 30 Oct 2011, JulesV wrote:

    This is the advice given in a study on the risk of stroke whilst taking aspirin...." Risk Factors for Spontaneous Hemorrhagic Stroke
    In the hope that through better patient assessment and counseling the risk of hemorrhagic stroke with aspirin can be reduced, this section discusses the known risk factors and comments on possible relation to aspirin use. The key risk factors include previous stroke and cerebral bleeding and a history of hypertension. Other noteworthy risks may include age, race, and amyloid angiopathy. Neoplasm, vasculitis, bleeding disorders, vascular malformations and aneurysms, trauma, age, and anticoagulant use also may increase risk. Persons most at risk are, therefore, older adults, particularly those with high blood pressure, those who may be overweight, sedentary, smoke, or have diabetes, suggesting that specific recommendations can be made to ensure that aspirin use is avoided in “at-risk” patients. The challenge for developing label recommendations for aspirin use is that many of these same risk factors predispose patients to thromboembolic events for which aspirin is indicated.http://stroke.ahajournals.org/content/36/8/1801.long
    Okay it's a bit hard to fit all this on the aspirin label. But how many people that have now read the BBC article on the presumed small benefits of avoiding the very scary bowel cancer will start taking aspirin without consulting their Doctor first?

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  • 58. At 1:37pm on 07 Nov 2011, Jerry Amos wrote:

    American College of Physicians posts "worse mortality" taking aspirin daily for people over 60 who haven't had a heart attack. Look at the whole picture, not just one condition.

    Concerned about colon cancer? There's a high degree of correlation between colon cancer and eating beef. Several studies confirm this, example, Scots who love their beef have a very high rate of colon cancer while Indians (who eat plant foods) living in exactly the same area don't. Genetics? Japanese moving to Hawaii eating their "traditional diets" have a low rate of "diseases of affluence" like cancer while their children eating "American diets" have similar rates as the local Americans.

    For more, read "The China Study" by eminent nutrition Cornell prof T. Colin Campbell and "The No-Dairy Breast Cancer Prevention Program" by world renowned scientist prof. Jane Plant, CBE. It's not just scientific studies, it's practical. My wife's nephew in his 40's had three cases of melanoma, went onto a Vegan diet, and his doctor was amazed at the improvement in his skin. No more melanoma.

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