Abstract
Dr. Tarek Haykal et al. (145:1795–1809, 2019) reported a meta-analysis of aspirin for the primary prevention of cancer in individuals without known cancer. The authors found that aspirin use was not associated with significant reduction in cancer mortality or incidence, but with higher rates of bleeding. The findings of this study added some evidence to the clinical practice. However, several issues might have compromised the strength of the evidence of this systematic review. If the investigators could have further clarified the inclusion and exclusion criteria, included all eligible studies, extracted data more meticulously, and performed more necessary sensitivity analyses to confirm the robustness of their findings, the strength of evidence of this meta-analysis would have been stronger.
This is a preview of subscription content, log in via an institution to check access.
References
Algra AM, Rothwell PM (2012) Effects of regular aspirin on long-term cancer incidence and metastasis: a systematic comparison of evidence from observational studies versus randomised trials. Lancet Oncol 13:518–527. https://doi.org/10.1016/S1470-2045(12)70112-2
Baron JA et al (2003) A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med 348:891–899. https://doi.org/10.1056/NEJMoa021735
Barton MK (2012) Daily aspirin reduces colorectal cancer incidence in patients with Lynch syndrome. CA Cancer J Clin 62:143–144. https://doi.org/10.3322/caac.21136
Burn J et al (2008) Effect of aspirin or resistant starch on colorectal neoplasia in the Lynch syndrome. N Engl J Med 359:2567–2578. https://doi.org/10.1056/NEJMoa0801297
Cook NR et al (2005) Low-dose aspirin in the primary prevention of cancer: the Women’s Health Study: a randomized controlled trial. JAMA 294:47–55. https://doi.org/10.1001/jama.294.1.47
Cook NR, Lee IM, Zhang SM, Moorthy MV, Buring JE (2013) Alternate-day, low-dose aspirin and cancer risk: long-term observational follow-up of a randomized trial. Ann Intern Med 159:77–85. https://doi.org/10.7326/0003-4819-159-2-201307160-00002
Critical Leg Ischaemia Prevention Study G, Catalano M, Born G, Peto R (2007) Prevention of serious vascular events by aspirin amongst patients with peripheral arterial disease: randomized, double-blind trial. J Intern Med 261:276–284. https://doi.org/10.1111/j.1365-2796.2006.01763.x
EAFT (European Atrial Fibrillation Trial) Study Group (1993) Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 342:1255–1262
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634. https://doi.org/10.1136/bmj.315.7109.629
Farrell B, Godwin J, Richards S, Warlow C (1991) The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry 54:1044–1054. https://doi.org/10.1136/jnnp.54.12.1044
Fowkes FG et al (2010) Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: a randomized controlled trial. JAMA 303:841–848. https://doi.org/10.1001/jama.2010.221
Gaziano JM et al (2018) Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet 392:1036–1046. https://doi.org/10.1016/s0140-6736(18)31924-x
Guyatt G et al (2013) GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. J Clin Epidemiol 66:151–157. https://doi.org/10.1016/j.jclinepi.2012.01.006
Hansson L, HOT Study Group et al (1998) Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the hypertension optimal treatment (HOT) randomised trial. Lancet 351:1755–1762. https://doi.org/10.1016/s0140-6736(98)04311-6
Haykal T et al (2019) Safety and efficacy of aspirin for primary prevention of cancer: a meta-analysis of randomized controlled trials. J Cancer Res Clin Oncol 145:1795–1809. https://doi.org/10.1007/s00432-019-02932-0
Higgins JGS (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. (2011)
Hull MA et al (2018) Eicosapentaenoic acid and aspirin, alone and in combination, for the prevention of colorectal adenomas (seAFOod Polyp Prevention trial): a multicentre, randomised, double-blind, placebo-controlled, 2 x 2 factorial trial. Lancet 392:2583–2594. https://doi.org/10.1016/s0140-6736(18)31775-6
Morimoto T, Nakayama M, Saito Y, Ogawa H (2007) Aspirin for primary prevention of atherosclerotic disease in Japan. J Atheroscler Thromb 14:159–166. https://doi.org/10.5551/jat.e482
Ogawa H et al (2008) Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA 300:2134–2141. https://doi.org/10.1001/jama.2008.623
Okada S et al (2018) Effect of aspirin on cancer chemoprevention in Japanese patients with type 2 diabetes: 10-year observational follow-up of a randomized controlled trial. Diabetes Care 41:1757–1764. https://doi.org/10.2337/dc18-0368
Peto R et al (1988) Randomised trial of prophylactic daily aspirin in British male doctors. Br Med J 296:313–316. https://doi.org/10.1136/bmj.296.6618.313(Clin Res Ed)
Schoenberger JA (1980) A randomized, controlled trial of aspirin in persons recovered from myocardial infarction. JAMA 243:661–669
The Coronary Drug Project Research Group (1980) Aspirin in coronary heart disease. Circulation 62:V59–V62
The DAMAD Study Group (1989) Effect of aspirin alone and aspirin plus dipyridamole in early diabetic retinopathy. A multicenter randomized controlled clinical trial. Diabetes 38:491–498
Vidal AC, Howard LE, Moreira DM, Castro-Santamaria R, Andriole GL, Freedland SJ (2015) Aspirin, NSAIDs, and risk of prostate cancer: results from the REDUCE study. Clin Cancer Res 21:756–762. https://doi.org/10.1158/1078-0432.CCR-14-2235
Yokoyama K et al (2018) Effects of daily aspirin on cancer incidence and mortality in the elderly Japanese. Res Pract Thromb Haemost 2:274–281. https://doi.org/10.1002/rth2.12097
Acknowledgements
This work was funded by The Science and Technology Development Fund, Macau SAR (File No. 130/2017/A3, 0099/2018/A3, 0096/2018/A3).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Wu, Q., Leung, E.L. The evidence strength of a meta-analysis of aspirin for primary prevention of cancer. J Cancer Res Clin Oncol 146, 2173–2175 (2020). https://doi.org/10.1007/s00432-019-03069-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-019-03069-w