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Associations between daily aspirin use and cancer risk across strata of major cancer risk factors in two large U.S. cohorts

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Abstract

Purpose

Daily aspirin use has been shown to reduce risk of colorectal, and possibly other, cancers, but it is unknown if these benefits are consistent across subgroups of people with differing cancer risk factors. We investigated whether age, body mass index (BMI), smoking status, physical inactivity, and family history of cancer modify the effect of daily aspirin use on colorectal, ovarian, breast, endometrial and aggressive prostate cancer risk.

Methods

We pooled 423,495 individuals from two prospective, U.S.-based studies: the NIH-AARP Diet and Health Study (1995–2011) and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (1993–2009). Using Cox proportional hazards regression, we examined associations between daily aspirin use (≥ 5 days/week) and risk of colorectal, ovarian, breast, endometrial, and aggressive prostate cancer, overall and across strata of risk factors.

Results

Daily aspirin use was associated with a 15% reduction in colorectal cancer risk (hazard ratio [HR]: 0.85, 95% confidence interval [CI] 0.80–0.89). Risk reductions were generally consistent across strata of risk factors but attenuated with increasing BMI (p-interaction = 0.16). For ovarian cancer, there was no significant association overall (HR: 0.93, 95% CI 0.80–1.08) but reduced risk among obese women (HR: 0.73, 95% CI 0.52–0.98, p-interaction = 0.12). Weak or null associations were observed for breast, endometrial, and aggressive prostate cancer, with no strong effect modification observed.

Conclusions

Daily aspirin use appears to reduce colorectal cancer risk regardless of other risk factors, though the potential modifying effect of BMI warrants further investigation and may need to be considered in risk–benefit calculations for aspirin use.

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Data availability

The data that support these findings are available from the NIH‐AARP Diet and Health Study and the PLCO Cancer Screening Trial. Restrictions apply to the availability of these data, which we obtained with specific data use agreements. Data are available with the permission of the AARP and PLCO studies.

Code availability

The code used in this study can be obtained from the study authors, by request.

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Funding

This work was supported by the Intramural Research Program of the National Cancer Institute at the National Institutes of Health (ZIA CP010128).

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Authors and Affiliations

  1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20850, USA

    Lauren M. Hurwitz, Kara A. Michels, Michael B. Cook, Ruth M. Pfeiffer & Britton Trabert

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  1. Lauren M. Hurwitz
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Correspondence to Lauren M. Hurwitz.

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Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical approval

The NIH-AARP Diet and Healthy Study and the PLCO Cancer Screening Trial were approved by institutional review boards at the National Cancer Institute, and both studies were performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki.

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All participants provided informed consent to participate in the NIH-AARP Diet and Healthy Study and the PLCO Cancer Screening Trial.

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Hurwitz, L.M., Michels, K.A., Cook, M.B. et al. Associations between daily aspirin use and cancer risk across strata of major cancer risk factors in two large U.S. cohorts. Cancer Causes Control 32, 57–65 (2021). https://doi.org/10.1007/s10552-020-01357-2

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  • DOI: https://doi.org/10.1007/s10552-020-01357-2

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