Low Dose Aspirin and Breast Cancer Prevention – Results from the CTS Cohort
Low-dose (81 mg) aspirin is recommended by USPSTF to reduce cardiovascular disease and colorectal cancer. As previous studies were inconclusive on the role of aspirin in the prevention of breast cancer, the aim of this study by Clarke et al. (Breast Cancer Res, 2017) was to determine whether hormone receptor subtypes (HR) and Her-2/neu receptor (HER2) status may be responsible for the variability in previous studies.
Observational Longitudinal Cohort: This study assessed data collected over several years from the California Teachers Study cohort. The cohort began in 1995-1996 and initially included 133,479 women, followed with baseline and ongoing annual questionnaires on family history and other cancer risk factors. The 2005-2006 questionnaire incorporated use of aspirin and other pain medications. In addition, the above data was linked to the California Cancer Registry and Office of Statewide Health Planning and Development which provides information on hospital services.
Key findings include:
Overall, current use of at least three tablets a week of any NSAID was not associated with breast cancer
3 or more tablets of low-dose aspirin per week was associated with a reduction in breast cancer, with a hazard ratio of 0.84 (95% CI 0.72-0.98)
The reduction in breast cancer was only observed in the case of positive HR/ HER2 negative status, with a hazard ratio of 0.80 (95% CI 0.66-0.96)
Timing and Frequency: 3 – 6 tablets of low-dose aspirin per week was further associated with breast cancer reduction compared to women not taking any NSAIDs during the past 3 years, with a hazard ratio of 0.72 (95% CI 0.54-0.96)
Similarly, this inverse association held for the HR positive/ HER negative status subtypes
Of note, the aspirin effect was seen with low-dose and not regular dose aspirin (325 mg)
This study demonstrates a 20% risk reduction for HR positive/Her2-negative breast cancer when low dose aspirin was used at least 3 times/week
Regular use, rather than sporadic use for pain may be a key factor in breast cancer reduction
Strengths of study:
Complete and accurate prospective data collection
Limitations of study:
Other possible confounders that were not obtained in the questionnaires (e.g. perhaps regular aspirin takers exercise more)
Observational and not interventional – questionnaires are ‘snapshots’ in time
Population used for this study may not mirror general population (e.g. educational status)
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