Aspirin Use for Targeted Breast Cancer

The indication to take aspirin to prevent various diseases has certainly been confusing over the last few years. A Veterans Administration (VA) study in the 1950’s noted that men over 45 years of age who took an aspirin per day had fewer heart attacks and strokes. The exact dosage of aspirin to take to prevent heart attacks and strokes has been the subject of many studies and much disagreement. In more recent times researchers have questioned whether aspirin should only be taken by those individuals who already have survived a heart attack or stroke for secondary prevention.

Taking aspirin is not risk free with users having a higher risk of gastrointestinal bleeding and cerebral hemorrhage especially if head trauma was involved. Recent studies have made it even more confusing with some experts not wanting patients to take aspirin for primary prevention of a first heart attack or stroke unless their 10 year risk of an event was 6% or greater. Others thought 6% was too high a figure and suggested 3%. The guidelines and suggestions for aspirin use to prevent cardiovascular disease have certainly become more confusing and have made the decision to use it far more complicated.

As a result of the use of aspirin in prevention of vascular and heart disease, researchers noted that people who took aspirin had fewer pre-cancerous adenomatous colon polyps and less skin cancer. In a 2010 study in the Journal of Clinical Oncology, Drs. Michelle Holmes and Wendy Chen of the Harvard Medical School noticed that women with breast cancer who took one aspirin per week had a 50% lower chance of dying from breast cancer. This observational study required a more detailed sophisticated double blind study to prove the point but the authors did not receive the necessary funding to begin the research study. This left the relationship between aspirin use and breast cancer development very unclear.

In the December 22, 2015 edition of the Mayo Clinic Proceedings, Bardia A, Keenan TE, and Ebbert JO and associates published data hinting that aspirin use was associated with a lower incidence of breast cancer for women with a history of breast cancer and those with a personal history of benign breast disease. This study of 26,580 postmenopausal women followed the study participants for three years. In the online journal Internal Medicine News, Neil Skolnik, MD talked about the exciting possibility of decreasing breast cancer in this specific group of women by 30 – 40% by taking a daily aspirin.

There is no question that aspirin therapy increases the risk of bleeding especially in the GI tract and the brain. Trauma and cuts will lead to increased bleeding and blood loss. Individuals will need to discuss with their physician the pros and cons of preventive aspirin therapy for heart disease prevention, skin cancer prevention, colon cancer prevention and now breast cancer prevention based on their personal and family medical history and balance it with the risk of bleeding.

Aspirin for Breast Cancer?

Aspirin (2)In an observational study published in the Journal of Clinical Oncology in 2010, Drs. Michelle Holmes and Wendy Chen of the Harvard Medical School showed that women with breast cancer who took one aspirin per week had a 50% lower chance of dying from breast cancer. They have been trying to set up a randomized blinded study of 3000 women with breast cancer to test this finding using the gold standard of research but they have been unable to raise the $10,000,000 required for a five year study. Pharmaceutical companies see no profit in aspirin and prefer to use their research money on medications that are potentially more profitable. Government agencies seem to feel the same way opting to test new cancer drugs pushed by pharmaceutical companies rather than finance an inexpensive available product.

The authors believe aspirin, if proven to be effective in randomized trials, is a less expensive alternative for women who cannot afford or cannot tolerate hormonal therapy post-surgery for five years. Great Britain, through its national health service has decided to study the effects of aspirin on four cancers, with breast cancer one of them, in a study that will not be completed until 2025. Drs. Holmes and Chen believe that with proper funding their study of women with stage 2 and 3 breast cancer, would answer the question of aspirin’s efficacy within five years.

Fish Consumption and Reduction of Risk of Developing Breast Cancer

Fish v2MedPage, the online medical journal of the University of Pennsylvania School Of Medicine reviewed an article published in the British Medical Journal concerning a relationship between consumption of marine fish oil from fish and a reduction in the risk of developing breast cancer. The study was published by Duo Li, MD, a professor of nutrition at Zhejiang University in Hangzhou, China. They reviewed data from 21 “prospective cohort studies involving nearly 900,000 people”. According to their data, eating just one or two portions a week of salmon, sardines, mackerel or other fish rich in marine n-3 polyunsaturated fatty acids is associated with a 1 % reduced risk of breast cancer in later life. Their data came from questionnaires that asked about patients’ intake of fatty acids and from blood levels measured in several studies. When they looked at similar fatty acids which come from plants not fish, such as alpha linoleic acid, they could not see a similar protective effect.

The study was critiqued by Alice H Lichtenstein, DSc, director for the cardiovascular nutrition lab at Tufts University. She had numerous questions and concerns about the methodology and conclusions but did support the need for future prospective studies to examine this question. While I have neither the credentials nor experience of Dr. Lichtenstein in evaluating this type of data I believe strongly in the KISS (keep it simple stupid) principle. Fleshy fish provides fish oils which are felt to be beneficial to our health. The same cannot be said for fish oils which you receive in pills and preparations.

My advice is to eat fish two or three times per week. Prepare it simply in a Mediterranean diet style and obtain the benefits that research seems to consistently show for this eating pattern.

Smoking Increases the Risk of Breast Cancer, Lung Cancer and Colon Cancer in Women

The Surgeon General of the United States issued another report on the dangers of smoking and its addictive potential last year.  At the time of release I was quite skeptical about the cost of the report and the need to remind Americans again that smoking is dangerous for you.  Then along comes a detailed review of the National Surgical Adjuvant Breast and Bowel Project. According to Stephanie Land, PhD, of the University of Pittsburgh, long-time smokers had a 59% increase in the risk of invasive breast cancer compared with nonsmokers.  The study looked at the links between four types of malignancy: breast, lung, colon, and endometrial cancer with smoking, alcohol use and leisure time activity.  The findings suggested that:

1.       Women who had smoked between 15 and 35 years had a 35% increase in the risk of breast cancer compared to non smokers. In that same group, if a woman smoked more than a pack a day she had a five – fold higher risk than non smokers.

2.       Women who had smoked 35 years or more had a 59% increase in the risk of breast cancer. These long-term smokers had a 30 times higher risk of lung cancer than non smokers.

3.       The risk of colon cancer among long–term smokers was five times higher than among non smokers.  A drink of alcohol a day reduced the risk of colon cancer by 65% compared to non drinkers.

4.       Inactive women had a 72% increased risk of uterine endometrial cancer compared to active participants in the study.

The study of almost 14,000 women highlighted the benefits of improving life style choices.  While researchers search for drugs and medication to prevent these life threatening illnesses, the study pointed out the benefits of altering the life style choices of women to prevent the development of cancer.

It is clear that smoking prevention and smoking cessation programs can do far more to prevent these cancers than pharmaceuticals. With cutbacks on funding for public health and the elimination of most health and hygiene classes in middle schools and high schools due to financial constraints, I wonder if we are being penny wise and pound foolish.