Should I take aspirin?

 
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Should I be taking aspirin every day? It's a question that I hear frequently and I guess will hear even more often after the latest research from scientists at the University of Oxford.

In a series of papers in the Lancet, the team, led by Professor Peter Rothwell found that a daily low dose of the cheap drug cut the risk of a range of cancers, and could even treat the disease.

Most startling were findings which suggest that aspirin can prevent the spread of cancer. The chances that cancer had already spread by the time it was diagnosed were cut by almost a third. The risk of cancer spreading in those already diagnosed was cut by at least a half.

Prof Rothwell said: "Aspirin has a big effect on the spread of the cancer which is important as it's the commonest reason that cancer kills people. We found that after five years of taking aspirin there was a 30-40% reduction in deaths from cancer."

You can read more about the research here.

Previous research by Prof Rothwell and colleagues found that daily aspirin use cut overall cancer deaths by a fifth over twenty years.

We already know that people at high risk of heart disease and stroke are often recommended to take aspirin for its protective effects.

An initial glance of the three papers would seem to tip the balance in favour of healthy middle-aged people popping a daily low dose (75mg) of aspirin.

A commentary by Andrew Chan and Nancy Cook from Harvard Medical School, described the research as "compelling" even though it did not include the two huge studies which did not show a reduced risk of cancer incidence or deaths after a decade of follow-up. These papers were excluded because they involved volunteers taking aspirin on alternate days.

I was contacted by Professor Janusz Jankowski, from Queen Mary, University of London, who is conducting a separate trial involving 2,500 patients looking specifically at aspirin and cancer prevention.

The trial is not yet published but Prof Jankowski said after more than four years follow-up they had found "zero" benefits. These are clearly disappointing results but such negative findings are unlikely to attract the same fanfare as Rothwell's positive outcome.

The elephant in the room with aspirin is internal bleeding. The dangers of bleeds, including in the stomach, intestines and brain are well-known. It's these adverse effects - which can be serious and even fatal - which have prevented doctors from recommending daily aspirin for healthy middle-aged people.

Prof Rothwell thinks it is time for guidelines to be reviewed in the wake of the evidence on cancer prevention.

I suspect many people may take the decision into their own hands. Cost is not an issue here - aspirin is about the cheapest drug there is - little more than a penny a pill.

But healthy adults considering daily aspirin need to know the potential risks and that they will effectively be medicalising themselves for many years as the benefits come from long-term use.

I wrote about my personal decision to take aspirin back in December 2010 when the first raft of Rothwell research came out.

In January 2012 I was asked whether I was still taking it, after medical trials showed that for those without a history of heart disease or stroke, aspirin was more likely to do harm rather than good.

I said I was, partly because I knew this new Rothwell research was due at some point. But for anyone still interested I have recently stopped because of a - as yet undiagnosed - gut complaint. I will talk to my doctor - and maybe have another look at the mounting research on this issue - before deciding whether to continue with aspirin.

Those without the time or inclination to wade through research papers should be helped in due course by further research on the risks and benefits of aspirin. But don't expect a simple, quick or straightforward answer to the question: "should I take aspirin every day?"

 
Fergus Walsh Article written by Fergus Walsh Fergus Walsh Medical correspondent

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