Baby Aspirin and Colorectal Cancer
- The United States Preventative Services Task Force will no longer recommend taking baby aspirin to prevent colorectal cancer to the general public because potential risks outweigh the rewards.
- The USPSTF does urge those between the ages of 40 and 60 who want to take baby aspirin to simply check with their doctor and make the choice that is best for them.
- “We do know that aspirin prevents blood cells or platelets from activating and producing an enzyme called thromboxane A2, which causes them to clump together. And tumors cant attach to these clumps,” Dr. Jane Figueiredo tells SurvivorNet.
The United States Preventive Services Task Force (USPSTF) says the evidence is inadequate that low-dose aspirin use reduces colorectal cancer incidence or mortality. That, combined with the potential side effects some people get when taking aspirin, led the group to determine the risks outweighed the rewards. Aspirin can cause life-threatening bleeding in the digestive tract or brain.
Read MoreThe group, however, is not instructing individuals to stop taking baby aspirin as a preventative measure, according to that spokesperson. Rather, the USPSTF is encouraging individuals who hope to start or continue taking baby aspirin speak with their doctors. That way, a professional familiar with an individual’s medical history can make an informed assessment as to whether the benefits outweigh the risks on a case-by-case basis.
Dr. Jane Figueiredo, director of community and population health research at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center, published a study on this topic earlier this year in the Journal of the National Cancer Insitute, and tells SurvivorNet the evidence is still strong for the benefits of a aspirin regimen.
“The updated analysis of the Task Force suggests a possible reduction in colorectal cancer risk with long-term aspirin use. But the report emphasizes that there isn't enough information yet,” says Dr. Figueiredo. “One concern they highlight is data from one trial that showed a potential higher risk of colorectal cancer mortality in older adults. We need more data and more discussion before making definitive statements.”
She continues: “The best approach may be more personalized anyone who wants to start or stop using aspirin should talk with their doctors to evaluate what the right choice is for them. ”
Dr. Figueiredo points out that baby aspirin can still do serious harm even though it is sold over-the-counter, does not require a prescription, and is not a controlled substance.
“Many people start using aspirin before talking with their doctor. The crucial takeaway from these new guidelines, is that before buying aspirin from the pharmacy, people should talk with their doctor to review their options and the risks and benefits of each option,” she explains.
Turning to her own study published this past May, which was funded by the American Cancer Society, Dr. Figueiredo says that her research showed “long-term aspirin use before a diagnosis of colorectal cancer was associated with a lower risk of colorectal cancer-specific mortality, but not aspirin use post-diagnosis.”
That study also clearly detailed the rewards and risks associated with taking baby aspirin.
“We found that long-term aspirin use was associated with a lower chance of having metastatic disease at the time of diagnosis,” notes Dr. Figueiredo. “At the same time, we know from the USPTF that there is a risk of bleeding with aspirin use. When assessing potential benefits of aspirin use, this risk should also be considered.”
In that study, Dr. Figueiredo details just how baby aspirin works to prevent cancer from spreading in some individuals.
“The underlying mechanisms of aspirin are not entirely known, but studies show that aspirin may inhibit platelet activation,” she explains. “This means that aspirin may prevent blood cells, or platelets from activating and producing an enzyme called thromboxane A2, which causes platelets to clump together. Inhibiting platelet activation could be one way aspirin plays a role in preventing tumor cells from metastasizing.”
Colorectal Cancer Screenings
Baby aspirin may be a decision to be made with your doctor, but the USPSTF still urges all eligible Americans to have their annual colonoscopy.
The guidance on that changed as well this year, with revised recommendations released in May.
The USPSTF lowered the age at which it recommended screenings to 45 while at the same time urging clinicians to offer the screening to those between the ages of 76 and 85.
“Discuss together with patients the decision to screen, taking into consideration the patient's overall health status (life expectancy, comorbid conditions), prior screening history, and preferences,” the panel said.
The USPSTF-accepted forms of testing for colorectal cancer are:
- High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every year
- Stool DNA-FIT every 1 to 3 years
- Computed tomography colonography every five years
- Flexible sigmoidoscopy every five years
- Flexible sigmoidoscopy every ten years + annual FIT
- Colonoscopy screening every 10 years
Dr. Heather Yeo Explains Why Colon Cancer Screening is Critical
Colorectal Cancer Facts
Symptoms of colon cancer include:
- A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that last for more than a few days
- A feeling that you need to have a bowel movement that’s not relieved by having one
- Rectal bleeding with bright red blood
- Blood in the stool, which might make it look dark brown or black
- Cramping or abdominal pain
- Weakness and fatigue
- Losing weight without trying
Since these issues can also be common symptoms for other illnesses and sometimes aren't always a cause for concern, it’s generally best to see a doctor to be on the safe side.
Related: Colon Cancer Screening Options and Genetics: Myth Busting With Dr. Heather Yeo
Dr. Heather Yeo, a colorectal surgeon at Weill Cornell in New York and a SurvivorNet medical advisor previously discussed the top three myths associated with colon cancer and getting screened.
Myth #1: Colonoscopies are the only way to detect colon cancer.
The verdict: Not true. Though colonoscopies are the best way, there are a lot of other methods like fecal occult blood tests (which look at a sample of your stool) and fecal immunochemical tests (FIT). "The [tests] have different roles, and you should talk to a medical provider about what's best for you, but there are a lot of options," Dr. Yeo says.
Myth #2: Only people with a family history can get colon cancer.
The verdict: Not true. "In fact, the majority of people who get colon cancer have no family history," Dr. Yeo says. "The reason I do the specialty is that if we screen patients early, cancers can be prevented. We can have really good survival outcomes, so I tell that to many of my patients. It's important to have a positive outlook for that."
Myth #3: Only people with symptoms need to screen.
The verdict: Absolutely not true. "The guidelines have recently changed because colon cancer has increased in people under the age of 50 … The American Cancer Society has recently recommended that we start screening at the age of 45," Dr. Yeo says. And that means everybody.
Dr. Heather Yeo Busts Some Myths About Colon Cancer Screening
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