Aspirin – Cardiovascular and Cancer Benefits

In this week’s on line edition of MedPage, a publication of the University Of Pennsylvania Perelman School Of Medicine, they summarize a series of articles published in the prestigious medical journal Lancet, which conclude that taking aspirin daily reduces your risk of cancer.

Aspirin received its notoriety after a Veterans’ Administration study years ago noted that if you took a daily aspirin and were a male over 45 years old you had fewer heart attacks and strokes. That classic study has led to the recommendation over the years that everyone over the age of 45 years old take aspirin daily to prevent cardiovascular events. No one can quite agree on the dosage of a full aspirin (325 mg), a baby aspirin (81 mg), or two baby aspirin?

As more and more people began taking aspirin for cardiovascular benefits researchers noted more frequent episodes of major internal bleeding either in the gastrointestinal tract or in the brain and head. At the same time, it was whispered among professionals that taking aspirin daily reduced adenomatous growths in the colon (pre-malignant polyps) and reduced colon cancer.   In the past few weeks several studies have tried to stratify whether aspirin use daily should be restricted to men as opposed to women, or to individuals with documented heart and vascular disease for secondary prevention of the next heart attack or stroke rather than primary prevention.  They cited the large number of bleeding episodes in individuals trying to protect themselves from their first heart attack or stroke compared to the events prevented and lives saved.

Today’s MedPage review of three Lancet articles claims that daily aspirin use reduces the risk of adenomatous cancer by 38% and cancer mortality by 15%. It reduces the development of metastatic disease by up to 15%.  These studies looked at more than 51 trials, including well over 100,000 participants, leading Dr Peter Rotwell of Oxford University in the United Kingdom to say that the papers “add to the case for the long term use of aspirin for cancer prevention in middle age.”

As a primary care physician I will continue to take my daily 81 mg enteric coated buffered aspirin (2) with food and take my chances with GI bleeding and cerebral hemorrhage.  If my patients do not have any strong contraindications to aspirin ingestion I will continue to make the suggestion that if they are over 45 years old they consider doing the same.

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“Colonoscopies Are Overdone In The Entire Population.”

Current recommendations by the American College of Gastroenterology call for colonoscopy as a screening test for colon cancer beginning at age 50 for Caucasians and 45 years old for African Americans. If the initial test is negative, and you have no symptoms, the recommended interval for follow-up colonoscopy is 10 years.  Despite this, a recent study published in the Archives of Internal Medicine revealed that nearly half of the the Medicare patients with negative findings on colonoscopy underwent repeat exams much sooner than the guideline recommended interval of 10 years.

The study looked at 24,000 Medicare enrollees who had a negative colonoscopy from 2001 through 2003.  Forty six percent of these individuals had a repeat exam in less than seven years.  According to lead author James S. Goodwin, M.D. of the University of Texas Medical Branch in Galveston, there was “no clear indication for the early repeated examination “in just under half of the recipients.   He said that even in patients 80 years of age and older repeat exams were done within 7 years in 32.9 % of the study group even though these patients were much more likely to die of something other than colorectal cancer in the near future.

Goodwin and his associates were surprised by the frequency of the repeat colonoscopies since Medicare regulations preclude reimbursement for screening colonoscopy within 10 years of a negative examination result. Despite this, only 2% of the repeat exams were denied by Medicare and not paid.

Brooks Cash, M.D., chief of medicine at the National Naval Medical Center in Bethesda, MD said, “I think colonoscopies are overdone in the entire population. “  He believes some of the frequent studies are provider driven and many are patient driven.

Colonoscopy is an invasive test with risks. The preparation can lead to fluid and electrolyte and volume problems in some individuals and the chance of a bowel perforation is rare but always present.  Patients need to talk to their personal physician about the need for a follow-up colonoscopy and the appropriateness of the timing suggested by the gastroenterologist before scheduling one.

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.