Role of Aspirin in Breast Cancer Survival
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Chemotherapy and hormonal therapy have significantly decreased breast cancer mortality, although with considerable side effects and financial costs. In the USA, over three million women are living after a breast cancer diagnosis and are eager for new treatments that are low in toxicity and cost. Multiple observational studies have reported improved breast cancer survival with regular aspirin use. Furthermore, pooled data from five large randomized trials of aspirin for cardiovascular disease showed that subjects on aspirin had decreased risk of cancer mortality and decreased risk of metastatic cancer. Although the potential mechanism for aspirin preventing breast cancer is not known, possible pathways may involve platelets, inflammation, cyclooxygenase (COX) 2, hormones, or PI3 kinase. This review article summarizes the current epidemiologic and clinical trial evidence as well as possible underlying mechanisms that justify current phase III randomized trials of aspirin to improve breast cancer survival.
KeywordsBreast cancer Aspirin Survival Inflammation COX-2
Compliance With Ethical Standards
Conflict of Interest
Wendy Y. Chen and Michelle D. Holmes have received aspirin and placebo from Bayer Pharmaceuticals for a randomized trial of aspirin for breast cancer survivors. Dr. Chen serves as the study chair, and Dr. Holmes serves as the co-principal investigator.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 2.• Huang XZ, et al. Aspirin and nonsteroidal anti-inflammatory drugs after but not before diagnosis are associated with improved breast cancer survival: a meta-analysis. Cancer Causes Control. 2015;26(4):589–600. This meta-analysis evaluates the association both including and excluding the randomized trial aspirin data CrossRefPubMedGoogle Scholar
- 5.Fraser, D.M., et al., Aspirin use and survival after the diagnosis of breast cancer: a population-based cohort study. Br J Cancer. 2014;111(3):623–7.Google Scholar
- 6.Holmes, M.D., et al., Aspirin intake and survival after breast cancer. J Clin Oncol. 2010;28(9):1467–72.Google Scholar
- 59.Dasari A, Messersmith WA. New strategies in colorectal cancer: biomarkers of response to epidermal growth factor receptor monoclonal antibodies and potential therapeutic targets in phosphoinositide 3-kinase and mitogen-activated protein kinase pathways. Clin Cancer Res. 2010;16(15):3811–8.CrossRefPubMedGoogle Scholar
- 66.• Domingo E, et al. Evaluation of PIK3CA mutation as a predictor of benefit from nonsteroidal anti-inflammatory drug therapy in colorectal cancer. J Clin Oncol. 2013;31(34):4297–305. This is one of several studies that show that the aspirin association for colorectal cancer is more strongly seen with PI3K mutant tumors CrossRefPubMedGoogle Scholar
- 70.Duggan, C., et al., Aspirin and serum estrogens in postmenopausal women: a randomized controlled clinical trial. Cancer Prev Res. 2014;7(9):906–912.Google Scholar
- 77.• Bowers LW, et al. NSAID use reduces breast cancer recurrence in overweight and obese women: role of prostaglandin-aromatase interactions. Cancer Res. 2014;74(16):4446–57. This study combines both epidemiologic and in vitro data to evaluate how NSAID use may decrease breast cancer recurrence CrossRefPubMedGoogle Scholar