Effect of aspirin on cancer incidence and mortality in older adults.

McNeil, John J; Gibbs, Peter; Orchard, Suzanne G; Lockery, Jessica E; Bernstein, Wendy B; Cao, Yin; Ford, Leslie; Haydon, Andrew; Kirpach, Brenda; Macrae, Finlay; McLean, Catriona; Millar, Jeremy; Murray, Anne M; Nelson, Mark R; Polekhina, Galina; Reid, Christopher; Richmond, Ellen; Rodríguez, Luz Maria; Shah, Raj C; Tie, Jeanne; Umar, Asad; van Londen, G.J.; Ronaldson, Kathlyn; Wolfe, Rory; Woods, Robyn L; Zalcberg, John; Chan, Andrew T; ASPREE Investigator Group

doi:10.1093/jnci/djaa114

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Access Status

Open access

Authors

McNeil, John J

Gibbs, Peter

Orchard, Suzanne G

Lockery, Jessica E

Bernstein, Wendy B

Cao, Yin

Ford, Leslie

Haydon, Andrew

Kirpach, Brenda

Macrae, Finlay

McLean, Catriona

Millar, Jeremy

Murray, Anne M

Nelson, Mark R

Polekhina, Galina

Reid, Christopher

Richmond, Ellen

Rodríguez, Luz Maria

Shah, Raj C

Tie, Jeanne

Umar, Asad

van Londen, G.J.

Ronaldson, Kathlyn

Wolfe, Rory

Woods, Robyn L

Zalcberg, John

Chan, Andrew T

ASPREE Investigator Group

Date

2020

Type

Journal Article

Metadata

Show full item record

Citation

McNeil, J.J. and Gibbs, P. and Orchard, S.G. and Lockery, J.E. and Bernstein, W.B. and Cao, Y. and Ford, L. et al. 2020. Effect of aspirin on cancer incidence and mortality in older adults. Journal of the National Cancer Institute.

Source Title

Journal of the National Cancer Institute

DOI

10.1093/jnci/djaa114

ISSN

0027-8874

Faculty

Faculty of Health Sciences

School

School of Public Health

Funding and Sponsorship

http://purl.org/au-research/grants/nhmrc/334047

http://purl.org/au-research/grants/nhmrc/1127060

Remarks

This is a pre-copyedited, author-produced version of an article accepted for publication in Journal of the National Cancer Institute following peer review. The version of record McNeil, J.J. and Gibbs, P. and Orchard, S.G. and Lockery, J.E. and Bernstein, W.B. and Cao, Y. and Ford, L. et al. 2020. Effect of aspirin on cancer incidence and mortality in older adults. Journal of the National Cancer Institut is available online at: https://doi.org/10.1093/jnci/djaa114.

URI

http://hdl.handle.net/20.500.11937/80802

Collection

Curtin Research Publications

Abstract

BACKGROUND: ASPirin in Reducing Events in the Elderly (ASPREE), a randomized double-blind placebo-controlled trial (RCT) of daily low-dose aspirin (100 mg) in older adults, showed an increase in all-cause mortality, primarily due to cancer. In contrast prior RCTs, mainly involving younger individuals, demonstrated a delayed cancer benefit with aspirin. We now report a detailed analysis of cancer incidence and mortality. METHODS: 19,114 Australian and U.S. community-dwelling participants aged 70+ years (U.S. minorities 65+ years) without cardiovascular disease, dementia or physical disability were randomized and followed for a median of 4.7 years. Fatal and non-fatal cancer events, a prespecified secondary endpoint, were adjudicated based on clinical records. RESULTS: 981 cancer events occurred in the aspirin and 952 in the placebo groups. There was no statistically significant difference between groups for all incident cancers (HR = 1.04, 95% CI = 0.95 to 1.14), hematological cancer (HR = 0.98, 95% CI = 0.73 to 1.30), or all solid cancers (HR = 1.05, 95% CI = 0.95 to 1.15), including by specific tumor type. However, aspirin was associated with an increased risk of incident cancer that had metastasized (HR = 1.19, 95% CI = 1.00 to 1.43) or was stage 4 at diagnosis (HR = 1.22, 95% CI = 1.02 to 1.45), and with higher risk of death for cancers that presented at stages 3 (HR = 2.11, 95% CI = 1.03 to 4.33) or 4 (HR = 1.31, 95% CI = 1.04 to 1.64). CONCLUSIONS: In older adults, aspirin treatment had an adverse effect on later stages of cancer evolution. These findings suggest that in older persons, aspirin may accelerate the progression of cancer and thus, suggest caution with its use in this age group.