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Cancer- ovarian

Primary Care Corner with Geoffrey Modest MD: Aspirin decreases risk of ovarian cancer

27 Feb, 14 | by EBM

Just after my sending out an article on aspirin in primary prevention of heart and other diseases, JNCI  has conveniently published an assessment of aspirin and ovarian cancer (see doi:10.1093/jnci/djt431). in this study the Ovarian Cancer Association Consortium reviewed the literature, finding 12 population-based case-controlled studies between 1992 and 2007, which included 7776 patients with ovarian cancer and 11,843 control subjects.  Findings:

–Overall ovarian cancer risk was reduced 9% with the use of aspirin
–Non-significant but similar reduction was found for non-aspirin NSAIDs, and no association with acetaminophen use
–7 studies assessed the frequency of aspirin use, finding that risk reduction was strongest among daily aspirin users, with a 20% risk reduction
–3 studies included dose information, finding that low dose aspirin (< 100 mg/d) was associated with the greatest risk reduction (34%). the studies also found that high dose of non-aspirin NSAIDs (>= 500 mg) was associated with a 24% reduced risk, but no relationship with acetaminophen
–Tumors of low malignant potential (n= 2059) were not associated with analgesic use (ie, it was not just the low-grade tumors that were decreased).  Aspirin use was associated with reduced risks of serous, endometrioid, and mucinous ovarian cancers (though only serous cancers reached statistical significance)

 so, ovarian cancer is the most lethal gynecologic malignancy with greater than 140,000 deaths per year worldwide.  There are some data suggesting that ovarian cancer may be related to chronic inflammation, creating a plausible mechanism for aspirin protection.  As I mentioned in a previous blog, there are relatively consistent data on aspirin use and decreased colorectal cancer (risk reduction on the order of 50%), but there also data of reduced risk of cancers of the esophagus, bladder, liver, lung, endometrium, and female breast.  It is important to remember that these are all secondary analyses of studies and therefore prone to bias.  However, these studies and their consistency do sway me to prescribing low-dose aspirin to people who are on the borderline for aspirin use for cardioprotection.

geoff

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