twice weekly aspirin use may decrease bc survivor's risk of metastasis by 62-71%

[Lani]

That is more than any other treatment known. In addition, NSAIDs may have similar properties. This is for bc as a whole, not her2+ bc, but if the effect is due to cox2 inhibition, her2+ breast cancers have been reported to be more often associated with excess prostaglandins (due to excess cox2 activity) than other breast cancer subtypes. NSAIDs are also known to be antiaromatase compounds, so the effect could be due to that effect...or many others ( I will be posting a fascinating paper by Dr. Feldman of Stanford on how vitamin D has cox2 inhibitory effects as well as breast-tissue specific anti-aromatase effects)

So here is what may be welcome news:


Aspirin Benefit Seen in Established Breast Cancer


Chalk up another use for aspirin: The drug appears to substantially reduce breast cancer survivors' risk of metastasis and death, researchers found.
An aspirin at least two days a week significantly reduced breast cancer death risk by 64% to 71%, Michelle D. Holmes, MD, DrPH, of the Channing Laboratory at Harvard and Brigham and Women's Hospital in Boston, and colleagues reported online in the Journal of Clinical Oncology.

The risk reduction for distant metastasis in breast cancer survivors taking aspirin at least two days a week was a significant 43% to 60% in the analysis of the Nurses' Health Study data through 2006.

This cut the risk of death from any cause nearly in half, Holmes' group noted.

These results could have "considerable clinical importance," they wrote, given the drug's relatively benign adverse effects compared with cancer chemotherapy agents as well as its other benefits in preventing colon cancer, cardiovascular disease, and stroke.

These findings were "all the more notable because the Nurses' Health Study did not find an association between aspirin use and breast cancer incidence," Holmes' group wrote.

Prevention of metastasis may be different, they said.

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) nonselectively block Cox-2 overexpression, which has been linked to metastasis of breast cancer, and also lower serum estradiol.

The anti-inflammatory effect of aspirin might itself hold benefits against cancer, added Lori Pierce, MD, of the University of Michigan in Ann Arbor, who commented on behalf of the American Society of Clinical Oncology.

However, she cautioned that aspirin isn't risk-free, noting it can cause GI bleeding.

Nevertheless, "these are promising findings, and if they are confirmed in additional clinical trials, physicians may be able to regularly recommend aspirin to their breast cancer patients to reduce risk of cancer spread and mortality," she wrote in a prepared statement.

Further study is needed to determine the mechanism and also to prospectively confirm the benefit, the investigators agreed.

The analysis included responses from 4,164 female registered nurses diagnosed with early stage breast cancer between 1976 and 2002 with follow-up through death or June 2006.

Aspirin use assessments in the first year after diagnosis were excluded since the drug is discouraged during chemotherapy.

Among these women who survived for more than a year after diagnosis, those who used aspirin more were less likely to subsequently die from breast cancer (P<0.001 for trend).

Compared with women who never used aspirin, the multivariate adjusted relative risk of breast cancer death was:

Similar for past users (RR 0.88, 95% confidence interval 0.64 to 1.22)
Similar for those with current use one day a week (RR 1.07, 95% CI 0.70 to 1.63)
Significantly lower for current two to five days-a week use (RR 0.29, 95% CI 0.16 to 0.52)
Significantly lower for current use six or seven days a week (RR 0.36, 95% CI 0.24 to 0.54)
For distant recurrence risk, the results were much the same (P=0.03 for trend).

The multivariate adjusted metastasis risks compared with women who never used aspirin was not reduced significantly with past (RR 1.03) or current one day a week use (RR 0.91) but was with two to five (RR 0.40, 95% CI 0.24 to 0.65) and six to seven days a week use (RR 0.57, 95% CI 0.39 to 0.82).

For overall mortality, the results were just as good (P=0.004 for trend), with multivariate-adjusted risk reductions of 47% for two to five day a week use (RR 0.53, 95% CI 0.37 to 0.76) and 46% for daily or nearly daily use (RR 0.54, 95% CI 0.41 to 0.70).

However, this appeared to be accounted for by the reductions in breast cancer-related deaths, the researchers noted.

Despite low statistical power, they found a suggestion of a breast cancer survival advantage with other NSAIDs but not with acetaminophen (Tylenol).

"The lack of association with acetaminophen suggests that the associations seen with aspirin and NSAIDs may represent biologically plausible effects and not just confounding by indication," Holmes and colleagues wrote in the JCO paper.

They cautioned, though, that the study was limited by use of self-reporting for aspirin intake, treatment, and distant recurrence.

Nor did the study have any information on aspirin dose, although most regular use was likely for heart disease prevention at the 81 mg/day level, they suggested.

And, although most breast cancer patients live at least five years, the results may be generalizable only to longer-term breast cancer survivors, they added.

[MJo]

I was reading the aspirin news yesterday and feeling sad, because aspirin really tears up my stomach. But twice a week I can handle.

[Vic]

What a nice and easy way to cut the risk of recurrence by taking an aspirin two to five times a week. What seemed interesting is the fact that "they found that women who took aspirin two to five days per week were 60% less likely to have a recurrence and 71% less likely to die from breast cancer. Those taking it more frequently had a 43% lower risk of recurrence and a 64% lower risk of death." Also stated in the article, "taking aspirin once a week produced no benefit."

From these numbers, it appears that it's better to take it in moderation, not every day of the week and not once a week, but somewhere between two and five days per week! Also, MJo, can you handle aspirin that's coated? Maybe that would help your stomach issues.

Wishing each of you an outstanding day.

Vicki

[Ruth Ann]

What is the dosage that you are suppose to take for the aspirin twice weekly? 81mg? 250mg? 500mg?
Thanks.
Ruth Ann

[StephN]

Interesting since I have been taking aspirin for my port cath clotting problem for a couple of years. And now that the port is out I cut my dose to 1/2 of the daily 325mg I was taking, and don't do that every day now.

Would be interesting to get a breakdown (if they did it) of HER2 positives in that group, and how many had the advantage of taking Herceptin.

As well as with the new hormonals, how many of those nurses took those along with the aspirin. Seems like there are other variables that should be factored in.

Questions, questions. My natural skepticism always asking!

[Christine MH-UK]

Hi Lani,

Nice find. I checked the JCO website and the full text of this one seems to be freely available (although sometimes websites recognise my computer, so I am not entirely sure).

Anyway, what puzzles me about this article is that it says in the full text that ER-negative and ER-positive seem to benefit, but when I look at the confidence intervals, all of the statistically significant benefits seem to be for ER-positive. Also, the article claims that all levels benefit, but it seems statistically significant for just stages I and II.

Still, for early stages and ER-positive this looks brilliant.

I would like to know your interpretation.

Best wishes,

Christine MH-UK

[Laurel]

Christine,

When you read the entire abstract did the dosage appear to be 81mg daily?

Thanks.

[Mary Jo]

I take one 325 mg. aspirin almost everyday of the week. I've been doing this since having my bilateral DIEP in June of 09. My plastic surgeon wanted me to take one 325 mg. aspirin for 30 days following the surgery - for obvious reasons - however, he said that he takes one 325 mg. aspirin daily for colon and heart health....and said if I wanted to continue he would say it was a good thing. So I have.

Thankfully, I have no stomach issues doing this. None whatsoever.

After reading this article however, I will cut out 2 or 3 days of taking the aspirin to probably 4 to 5 days a week.

It's very encouraging news for us and it's also good for our health for other reasons.....

Mary Jo

[Jackie07]

Just took my first aspirin...

[Vic]

Yes, the article stated 81 mg. per day and I just bought a bottle of the low dose, safety coated aspirins by Bayer.

To our health!

Vicki

[Joe]

is attached:

[Rich66]

A bit more on aspirin HERE

[Christine MH-UK]

It is actually the full version of the article that I was able to get off the JCO website, not just the abstract.

Here is what it says word for word:

"We lack details on aspirin dose. If there is a dose response, the effect size in the current study may be diminished because frequent aspirin users may be more likely to be low-dose users attempting to prevent heart disease."

Since the effect seems to be much stronger in women who take aspirin two days a week rather than seven, there is a suggestion that it is normal dose rather than low dose aspirin matters.

Best wishes,

Christine

[Vic]

It looks like a number of good links have been posted; the article I read in the "Los Angeles Times" said 81 mg.

Here is the quote pulled from the article: "The researchers did not monitor aspirin dosage, but the majority of the women taking aspirin did so for its heart benefit, and thus were taking 81 milligrams per day, less than a normal dose."

It was on page two of the article, which you can read in its entirety here: http://articles.latimes.com/2010/feb...in17-2010feb17

Hope this helps.

Vicki

['lizbeth]

So what is the concensus? 325 or 81mg? I had 81 handy so I am taking that 3 -5 times per week.

[curryalso]

My oncologist told me not to take the asprins while on chemo or radiation. What about it?

[Laurel]

Curryalso,

I think that is sound advice as your platelets will drop and you do not want to have any thinning effect from aspirin on top of low counts. I am sure post-chemo, once your counts are back up, is soon enough.

[Debbie L.]

There have been quite a few observational studies that show an association between NSAIDs (including aspirin) and cancer behavior. But there are limitations to observational, retrospective studies. Gary Schwitzer does a nice job of discussing that in his blog:

http://www.healthnewsreview.org/blog...l-studies.html

tinyurl: http://tinyurl.com/yzrz6s3

Personally, I think there's something here (but opinion is far worse than observational studies, laughing). And in small doses, allergies or major GI issues excepted, it seems like a "can't hurt, might help" kind of thing to take 81mg of aspirin, which we know may have other benefits also.

But I'm reminded by critical-thinking and experienced health advocates that this same study (Nurses Study, which I happen to be part of), is the one that had the strongest "evidence" for HRT use as cardioprotective and breast cancer safe. Which isn't to diss this particular study but to point out the potential failings of observational studies.

And while I'm at it, I'll add my own thoughts. IF it's true that NSAIDs affect cancer behavior (and as I said, I do think that it is true at least to some degree), then it seems to me that we need to look at all the AI studies with this in mind as a confounder. Most of the women I know who are on AI's have some degree of pain. And for that pain, most of them take Ibuprofen in varying amounts. That fact could be a big confounder in the AI studies. NSAID use could affect the cancer's behavior directly and/or it could be a marker for those who are metabolizing the drug most effectively (thus getting the most symptoms). Or, maybe the pain issue is totally random (in relation to efficacy/metabolism) BUT the use of the NSAIDs by those experiencing the pain makes it appear that the pain is a marker for efficacy (as reported by Jack Cusick in 08), when it's actually the NSAID use for the pain that's making the difference.

Phew, that's easier to think about in my head than to put on paper.

Debbie Laxague

[Jackie07]

Debbie,

Thank you so much for the illumination. I was thinking abut something similar - that there's an explanation besides plain aspirin - but wasn't able to put the reasoning together.

The drawback of any statistic/study is that the number itself does not explain the reason behind it. Many of the Chinese medicine - herbs, acupuncture - have been practised based on their effectiveness after being implemented/experiemented on a vast population over long period of time. New researches and studies are just beginning to figure out the rationale behind it and make them available in a more efficient way.

Medicine has saved numerous lives that would otherwise not pass the genes to the next generation. Our generation (and the future generations) are defying the odds of Darwinism thanks to the advancement of modern science. I know I would not have survived childhood dieseases had I been born 20, 30 years earlier. And I would not have survived my 23-hour brain surgery had it been done 10, 15 years earlier.

Hopefully we can all survive long enough before another miracle drug/combination becomes available. Before then, I'm going to take my aspirin...

Thanks again.