Published Oct 16, 2021
A panel of top health experts no longer recommends taking aspirin for the prevention of colorectal cancer, but experts tell SurvivorNet an aspirin regimen could be useful if the pros and cons are weighed with your physician.
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.
In 2016, the panel encouraged doctors to prescribe some patients aspirin to prevent cardiovascular disease and colorectal cancer.
The new guidance from the group changes the recommendations around aspirin use and cardiovascular disease. The USPSTF recommends “that the decision to initiate low-dose aspirin use for the primary prevention of CVD in adults ages 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one, and recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults age 60 years or older.”
When SurvivorNet reached out to the USPSTF, a spokesperson said that the group did not have enough research available to release new guidance on colorectal cancer.
The 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.”
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:
Symptoms of colon cancer include:
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.
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.
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.”
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.