Aspirin and Breast Cancer: The Media Does It Again!

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“Aspirin Intake and Survival,” as reported by M. Holmes et al and published in the Journal of Clinical Oncology, was released ahead of print publishing, the day before yesterday. One more time, major media buzz has occurred, again leaving medical professionals scratching their heads over what the fuss is about.

This is an observational study, relying on self-reporting of aspirin use four years after breast cancer diagnosis. Study participants had Stage I-III breast cancer while enrolled in the Nurses’ Health Study. The results are provocative, and are suggestive—suggestive, mind you, not conclusive—of the possible benefit of taking aspirin in preventing distant recurrences (cancer popping up in other parts of the body) and deaths due to breast cancer. Presumably this works on the basis of the anti-inflammatory effects of aspirin, but the exact mechanism is not clear.

Observational studies are suggestive but not definitive. Data on actual dose, schedule, and distant cancer details were not available and the data-gathering relied on the memories of the study participants. Then again, women also had to live long enough to report on their aspirin use, approximately four years after diagnosis. This was not a randomized controlled clinical trial, where women are assigned to receive a specified dose and schedule of treatment (versus no treatment), with the survival endpoint clearly defined and with documentation of distant recurrences. Other breast cancer treatment also has to be carefully taken into account.

Although provocative, these results must be interpreted with caution. Aspirin is not a benign drug and can cause bleeding, especially from the stomach. Aspirin has not been shown to be of clear benefit in preventing breast cancer incidence, or helpful in women with metastatic cancer. Other non-steroidal anti-inflammatory agents might also be beneficial, but the data is lacking here as well.

Aspirin use is currently indicated for prevention of cardiovascular disease and stroke, and might decrease risk for colon cancer. Breast cancer recurrence and death have been decreased by chemotherapy and targeted treatment, including anti-estrogens and the drug Trastuzamab, when indicated. Lifestyle modifications, including low fat diet, exercise, maintaining a healthy weight, and limiting alcohol intake may also decrease breast cancer occurrence, recurrence, and mortality. Every survivor should discuss her own personal risk with her treating physicians and establish a personalized program. At this time, routine use of aspirin is not indicated—and won’t be, until these interesting results are confirmed in a properly conducted prospective trial.

Bonnie S. Reichman, M.D., is a Clinical Associate Professor of Medicine at the Cornell University Medical College and an Attending Medical Oncologist at The New York Hospital-Cornell Medical Center. A nationally respected researcher, she has presented at many national and international cancer symposia, contributed numerous articles and book chapters, and is an advocate of patients’ rights and education. Dr. Reichman is a member of the Women’s Voices for Change Medical Advisory Board.

MD, F.A.C.P., is a Clinical Associate Professor of Medicine at the Weill Medical College of Cornell University; an attending medical oncologist at The New York Presbyterian Hospital. Dr. Reichman is especially interested in the issues confronting women who are diagnosed with breast cancer and has built her practice to meet the medical, psychosocial, and educational needs of this unique patient population and their families. Dr. Reichman is a past President of the New York Metropolitan Breast Cancer Group, Inc. She serves on the Executive committee of the New York State Society of Oncologist and Hematologists, Inc., and is on the Medical Advisory Board of New York Komen for the Cure, and is on the membership committee of the American Society of Breast Diseases. She was a member of the Board of SHARE, and was on the Board of Directors of the National Alliance of Breast Cancer Organization (NABCO). She is a recipient of the Gay Clark Stoddard Memorial Award from the NYC affiliate of Komen for the Cure. Her prior appointments include Medical Director, Salick Healthcare at 61st Street, NYC, Associate Medical Director, Strang Cancer Prevention Center; Director of Medical Oncology, Strang-Cornell Breast Center; and attending physician, Memorial Sloan-Kettering Cancer Center. Dr. Reichman is a graduate of Cornell University College of Arts and Sciences and the St. Louis University School of Medicine. She completed her internship/residency training at the Cornell University Cooperating Hospitals at the North Shore University Hospital and the Memorial Sloan-Kettering Cancer Center. She completed her fellowship training at the Memorial Sloan-Kettering Cancer Center where she was an American Cancer Society fellow. She is board certified in medical oncology and internal medicine. Dr. Reichman is a nationally respected researcher and has presented at many national and international cancer symposia. She has contributed numerous articles, abstracts and book chapters, and is an advocate of patients’ rights and education.