新资料证实每天一颗阿斯匹灵可降低癌症死亡率


  【24drs.com】一篇新研究结果支持每天使用阿斯匹灵,以帮助预防死于癌症。不过,美国癌症协会(ACS)的Eric J. Jacobs医师表示,对于可能的效益有多大,仍有疑问。
  
  Jacobs医师表示, 其研究动机是,最近有一篇分析汇整了现有的每日服用阿斯匹灵预防心血管事件的结果,发现服用阿斯匹灵5年以上者,其癌症死亡率估计降低了37%[Lancet. 2012;379:1602–1612]。
  
  但是还不确定每天使用多少量的阿斯匹灵可降低癌症死亡率。那篇汇整分析的样本数有限,两篇相当大型之隔天服用阿斯匹灵的随机试验发现对于整体癌症死亡率没有效果。
  
  为了厘清每天服用多少剂量阿斯匹灵可降低癌症死亡率风险,Jacobs医师等人分析了「Cancer Prevention Study II Nutrition Cohort」研究,于问卷中表示有使用阿斯匹灵之100,139名年长者的资料。
  
  研究在线刊载于8月10日的美国国家癌症研究院期刊。
  
  这些研究对象在研究开始时没有癌症,追踪期最长达11年;研究者发现,包括每天服用阿斯匹灵至少5年或短期每天使用者,每天使用阿斯匹灵与癌症死亡率整体风险降低16%有关。
  
  整体癌症死亡率降低,主要是胃肠道癌症(例如食道、胃与结肠直肠癌)比率降低约40%以及胃肠道之外的癌症降低约12%。
  
  Jacobs医师表示,虽然最近有关使用阿斯匹灵和癌症的证据令人鼓舞,但仍不足以建议人们开始服用阿斯匹灵以预防癌症。
  
  他解释,即使是低剂量阿斯匹灵也可能会显著增加严重胃肠道出血风险;有关使用阿斯匹灵的决定,应考虑个人病史而衡量风险,必须和健康照护专业人士谘商后才可以做决定。
  
  他指出,专家委员会发展临床指引、更新阿斯匹灵使用指引时将考量风险与利益的整体证据。
  
  Jacobs医师希望这篇研究和最近其它有关阿斯匹灵的效益研究,将可更深入探讨每天使用和长期使用阿斯匹灵,以更清楚了解阿斯匹灵对特定癌症的效果。
  
  北卡罗来纳大学医学院的John A. Baron医师在编辑评论中指出,整体而言,这篇进行良好的ACS研究呼应了有关阿斯匹灵和癌症死亡率的其它资料,但是没有明确确认。
  
  他指出,使用阿斯匹灵和癌症的宏观面是相当正面的,这项药物的确降低了胃肠腔炎症的发生率和死亡率,对其它癌症也可能有类似影响。「只要吃一颗药就可能可以预防癌症发生和死亡」,这是令人兴奋的。
  
  不过,就像Jacobs医师所说的,Baron医师呼吁,对于建议使用阿斯匹灵以预防癌症要谨慎。
  
  他表示,阿斯匹灵有效并不意味著是否必要使用;阿斯匹灵确实是有毒性的一种药物,至于预防性介入,必须衡量利益与风险,特别是效益比风险更低或更慢发生时。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6907&x_classno=0&x_chkdelpoint=Y
  

An Aspirin a Day Lowers Cancer Mortality, New Data Confirm

By Fran Lowry
Medscape Medical News

August 10, 2012 — Results from a new study support the daily use aspirin to help prevent death from cancer.

However, questions remain about the size of the potential benefit, lead author Eric J. Jacobs, MD, from the American Cancer Society (ACS) in Atlanta, Georgia, told Medscape Medical News.

"We were prompted to do the study because a recent analysis pooling results from existing randomized trials of daily aspirin for the prevention of vascular events found an estimated 37% reduction in cancer mortality among those using aspirin for 5 years or more [Lancet. 2012;379:1602–1612]," Dr. Jacobs said.

"But uncertainty remains about how much daily aspirin use may lower cancer mortality. The size of this pooled analysis was limited, and 2 very large randomized trials of aspirin taken every other day found no effect on overall cancer mortality," he explained.

To clarify how much daily aspirin use might lower the risk for fatal cancer, Dr. Jacobs and his colleagues analyzed information from 100,139 predominantly elderly participants in the Cancer Prevention Study II Nutrition Cohort who reported using aspirin on questionnaires.

The study was published online August 10 in the Journal of the National Cancer Institute.

The participants, who did not have cancer at the start of the study, were followed for up to 11 years.

The researchers found that daily aspirin use was associated with an estimated 16% lower overall risk for cancer mortality, both among people who reported taking aspirin daily for at least 5 years and among those who reported shorter-term daily use.

The reduction in overall cancer mortality was driven by a decrease of about 40% for cancers of the gastrointestinal tract (such as esophageal, stomach, and colorectal cancer) and a decrease of about 12% for cancers outside the gastrointestinal tract.

Too Soon to Recommend Aspirin to Prevent Cancer

"Although recent evidence about aspirin use and cancer is encouraging, it is still premature to recommend that people start taking aspirin specifically to prevent cancer," Dr. Jacobs said.

"Even low-dose aspirin can substantially increase the risk of serious gastrointestinal bleeding. Decisions about aspirin use should be made by balancing the risks against the benefits in the context of each individual's medical history, and any decision should be made only in consultation with a healthcare professional," he explained.

He added that expert committees developing clinical guidelines will consider the totality of the evidence on risks and benefits when guidelines for aspirin use are updated.

"I hope this study and other recent promising research about aspirin will lead to studies that look very carefully at daily aspirin use over long periods of time to more clearly understand aspirin's effects on specific cancers," Dr. Jacobs said.

Big Picture Is Positive

In an accompanying editorial, John A. Baron, MD, from the University of North Carolina School of Medicine in Chapel Hill, writes that "overall, the well-conducted ACS study is an echo of other data on aspirin and cancer mortality, not a resounding confirmation."

The "big picture" on aspirin use and cancer is "very positive," he noted. "The drug clearly reduces the incidence and mortality from luminal gastrointestinal cancers, and it may similarly affect other cancers. This is exciting: simply taking a pill can prevent cancer incidence and cancer death."

However, like Dr. Jacobs, Dr. Baron urges caution with regard to the widespread recommendation to use aspirin to prevent cancer.

Just because aspirin is effective "does not mean it necessarily should be used. Aspirin is a real drug, with definite toxicity. As for any preventive intervention, the benefits must be balanced against the risks, particularly when the benefits are delayed whereas the risks are not," he writes.

Dr. Jacobs has disclosed no relevant financial relationships. Dr. Baron reports being a consultant to Bayer, and holding a use patent for the chemopreventative use of aspirin, currently not licensed.

J Natl Cancer Inst. Published online August 10, 2012.

    
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