An aspirin a day…

Research has demonstrated that taking aspirin every day could reduce the risk of colon cancer in those with a genetic predisposition. What impact could this research have on the future of aspirin use in modern day medicine?

Aspirin is often thought of as a "run of the mill" household painkiller. However, it has long been known to have other beneficial properties, which have been harnessed for use in fighting heart disease and preventing blood clots. To add to its plethora of uses, research published in The Lancet has demonstrated that taking aspirin every day could also reduce the risk of colon cancer in those with a genetic predisposition.

The research study involved 861 participants with Lynch Syndrome, a rare hereditary disorder. Lynch Syndrome is caused by a mutation in genes involved in DNA repair and is diagnosed through genetic testing (consisting of a blood test).  It is associated with a high risk of colon cancer, such that patients with the syndrome are estimated to have an 80% chance of developing colon cancer over their lifetime. Those diagnosed with Lynch Syndrome are also at an increased risk for developing other types of cancer (including endometrial, ovarian, stomach, and small intestine).

The comprehensive study was carried out by over 30 researchers from hospitals and universities in 13 different countries. For the purpose of the study, the 861 participants were randomly assigned to one of two groups. Over a period of two years one group was given 300mg of aspirin twice a day; the other received a placebo. The participants were then followed up for 5 – 10 years.

Analysis of the data collected revealed that, within two years, 20 participants (10 from the aspirin group, and 10 from the placebo group) had developed colon cancer. By 10 or more years, 28 more participants had developed colon cancer; however, only 8 were from the aspirin group, compared to 20 from the placebo group. This equated to a 44% lower rate of colon cancer in the aspirin group, when compared with the placebo group. Even at the end of the study neither the participants nor the investigators were told which participants had received the placebo, and which had received aspirin. This helped to ensure an unbiased analysis of the long term follow up data.

For sufferers of Lynch Syndrome this is clearly significant. The researchers concluded that: 'the case for prescription of aspirin to this high-risk group is clear', and it seems likely that this advice will be heeded. However, further research will be required to establish a recommended dosage, and duration of aspirin treatment.

For the wider medical community, this research demonstrates how pharmaceuticals that have already been through rigorous testing and approval for one application can be used across a variety of alternative treatment pathways. Aspirin was first developed by pharmaceutical company, Bayer, in the second half of the nineteenth century (aspirin was initially Bayer's brand name) and has been in widespread use for 150 years. There have been multiple clinical trials relating to aspirin: into its efficacy as an anti-clotting agent, in the 1960s and 1980s; and into its ability to prevent heart attacks, in the 1970s and 1980s. Its risk profile for these uses, including possible side effects (e.g. ulcers), is therefore well known.

Where it can be proven, the benefit of using an established pharmaceutical product in a novel treatment situation should mean that the product can be more swiftly adopted as a possible treatment, without requiring the extensive research into long term side effects necessary with a product that is new to the market. It remains to be seen what other benefits "everyday" medicines, such as aspirin, could have.