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Safety and efficacy of aspirin for primary prevention of cancer: a meta-analysis of randomized controlled trials

  • Review – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

In the United States, cancer is the second leading cause of mortality, and millions more battle cancer worldwide. As such, primary prevention of cancer is a major interest globally. Aspirin has been studied as a primary prevention method for multiple diseases, mainly cardiovascular disease and various forms of cancer. The role of aspirin as a primary prevention of cancer is still controversial and may be more beneficial in certain cancers over others. With rapidly surfacing large randomized controlled trials (RCTs) studying this subject, we aimed to evaluate the efficacy and safety of aspirin as a primary prophylaxis for cancer.

Methods

A comprehensive electronic database search was conducted for all RCTs that compared aspirin versus placebo for the prevention of any type of disease, and where cancer incidence or mortality was reported. The primary outcome was cancerrelated mortality. Secondary outcomes were cancer incidence, all-cause mortality, major bleeding, any bleeding and gastrointestinal (GI) bleeding. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model at the longest follow-up period.

Results

We included 16 RCTs with 104,018 total patients, mean age of 60.51 years, mean follow-up of 5.48 years, and a male percentage of 38.72%. We found that aspirin was not associated with a significant reduction of cancer-related mortality compared with placebo (RR 0.99; 95% CI: 0.87–1.12; P = 0.85: I2 = 41%). Compared with placebo, aspirin was not associated with significant reduction of all-cause mortality (RR 0.97; 95% CI: 0.92–1.02; P = 0.19; I2 = 13%) or cancer incidence (RR: 0.98; 95% CI: 0.92–1.04; P = 0.43; I2 = 16%). However, aspirin treatment was associated with significantly increased risks of any bleeding (RR 1.63; 95% CI: 1.31–2.03; P < 0.01), major bleeding (RR 1.41; 95% CI: 1.26–1.57; P < 0.01), and GI bleeding (RR 1.85; 95% CI: 1.38–2.48; P < 0.01) compared with placebo.

Conclusion

Our study did not find any significant reductions in cancer-related mortality or cancer incidence when compared aspirin use with placebo or no aspirin. Our study also highlights that the use of aspirin for primary prevention of cancer was found to cause higher rates of bleeding (any bleeding, major bleeding, and GI bleeding) compared to placebo or no aspirin at the longest follow-up period with no significant benefit in cancer primary prevention.

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Authors and Affiliations

  1. Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA

    Tarek Haykal, Mahmoud Barbarawi, Yazan Zayed, Anitha Yelangi, Harsukh Dhillon, Sowmya Goranta, Babikir Kheiri, Adam Chahine, Varun Samji & Ghassan Bachuwa

  2. College of Human Medicine, Michigan State University, East Lansing, MI, USA

    Tarek Haykal, Mahmoud Barbarawi, Yazan Zayed, Anitha Yelangi, Harsukh Dhillon, Sowmya Goranta, Babikir Kheiri, Adam Chahine, Varun Samji & Ghassan Bachuwa

  3. Department of Anesthesiology, Lebanese University, Beirut, Lebanon

    Josiane Kerbage

  4. Genessee Hematology & Oncology, PC, Flint, MI, USA

    Khalil Katato

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  1. Tarek Haykal
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  2. Mahmoud Barbarawi
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  3. Yazan Zayed
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Correspondence to Tarek Haykal.

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Haykal, T., Barbarawi, M., Zayed, Y. et al. 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 (2019). https://doi.org/10.1007/s00432-019-02932-0

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  • DOI: https://doi.org/10.1007/s00432-019-02932-0

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