Effect of aspirin on cancer incidence and mortality in older adults.
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 individual...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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2020
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| Online Access: | http://purl.org/au-research/grants/nhmrc/334047 http://hdl.handle.net/20.500.11937/80802 |
| _version_ | 1848764273551998976 |
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| author | 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 |
| author_facet | 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 |
| author_sort | McNeil, John J |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | 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. |
| first_indexed | 2025-11-14T11:16:44Z |
| format | Journal Article |
| id | curtin-20.500.11937-80802 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | eng |
| last_indexed | 2025-11-14T11:16:44Z |
| publishDate | 2020 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-808022021-01-07T07:46:47Z 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 ASPREE Investigator Group 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. 2020 Journal Article http://hdl.handle.net/20.500.11937/80802 10.1093/jnci/djaa114 eng http://purl.org/au-research/grants/nhmrc/334047 http://purl.org/au-research/grants/nhmrc/1127060 http://creativecommons.org/licenses/by/4.0/ fulltext |
| spellingShingle | ASPREE Investigator Group 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 Effect of aspirin on cancer incidence and mortality in older adults. |
| title | Effect of aspirin on cancer incidence and mortality in older adults. |
| title_full | Effect of aspirin on cancer incidence and mortality in older adults. |
| title_fullStr | Effect of aspirin on cancer incidence and mortality in older adults. |
| title_full_unstemmed | Effect of aspirin on cancer incidence and mortality in older adults. |
| title_short | Effect of aspirin on cancer incidence and mortality in older adults. |
| title_sort | effect of aspirin on cancer incidence and mortality in older adults. |
| topic | ASPREE Investigator Group |
| url | http://purl.org/au-research/grants/nhmrc/334047 http://purl.org/au-research/grants/nhmrc/334047 http://hdl.handle.net/20.500.11937/80802 |