NSAIDS Aspirin and Breast Cancer

Cancer Connect

by Dr. C.H. Weaver M.D. updated 5/2020

Researchers from Dana-Farber Cancer Institute and Brigham and Women’s Hospital (BWH) received a $10 million Breakthrough Award from the Department of Defense’s Office of the Congressionally Directed Medical Research Program to test whether aspirin helps women with breast cancer avoid recurrence and live longer. This is the first ever randomized trial in the United States testing aspirin in the disease, which impacts more than 3 million American women who are living with a breast cancer diagnosis.

The Aspirin for Breast Cancer (ABC) Trial is recruiting 3,000 women with Stages II and III breast cancer to participate in the study. Women participating in the trial will be randomly assigned to receive aspirin or a placebo pill.

Previous observational research, where scientists observe peoples’ behavior, and correlate that behavior with their health, has found that breast cancer survivors who were regular aspirin users had a 50 percent lower risk of breast cancer recurrence and death compared to those who did not use aspirin. This, along with other promising preclinical research, has led to intense interest among physicians and survivors to explore the therapeutic benefits of aspirin.

“This trial is the first of its kind in United States,” said Eric Winer, MD, Director of Breast Oncology Program, Professor of Medicine, and Thompson Chair of Breast Cancer Research at Dana-Farber Cancer Institute. “The potential benefits of aspirin in preventing breast recurrence are significant and we look forward to determining if aspirin could augment current therapies. This is a treatment that needs to be evaluated further,” emphasized Dr. Winer, who is also a Partnering PI of the grant.

Background Research on Aspirin and Breast Cancer

The use of non-steroidal anti-inflammatory drugs (NSAIDS), including both aspirin and ibuprofen, appears to significantly reduce the risk of developing breast cancer. Researchers recently conducted a large meta-analysis including results from several studies exploring the potential association between the use of NSAIDs and the risk of breast cancer. The analysis included over 2,788,000 women, and separate analyses were conducted for ibuprofen and aspirin use.

  • NSAID use was associated with a 12% reduction in breast cancer incidence.
  • Use of aspirin and ibuprofen yielded similar results in risk of breast cancer.

The researchers concluded that the meta-analysis provides evidence that NSAID use is associated with reduced risk for breast cancer. All individuals should speak with their healthcare provider before using any NSAIDS, as all medications are associated with side effects.

Regular Aspirin Use May Also The Reduce Risk of Hormone-positive Breast Cancer

According to another study published in Breast Cancer Research regular use of aspirin may modestly reduce the risk of developing hormone-positive breast cancer. Breast cancer is one type of cancer for which research continues to explore a potential association between NSAID use and incidence. Because the mechanism through which NSAIDs work include the suppression of estrogen, researchers speculated that NSAID use may reduce the risk of hormone-positive breast cancer. Hormone-positive breast cancer, also referred to as estrogen receptor (ER)-positive breast cancer, is the most common type of breast cancer and is stimulated to grow from exposure to the female hormones estrogen and/or progesterone.

Researchers evaluated data from the National Institutes of Health–AARP Diet and Health Study, which included 127,383 female AARP (formerly known as the American Association of Retired Persons) members. Participants were aged 51 to 72 years, had no history of cancer, and completed questionnaires that included information regarding use of NSAIDS and breast cancer incidence.

  • There was no overall association between the use of NSAIDS and breast cancer.
  • Regular aspirin use reduced the risk of hormone-positive breast cancer by 16%.
  • Aspirin and other NSAID use did not demonstrate a reduced risk of hormone-negative breast cancer.
  • NSAIDS other than aspirin did not demonstrate a reduced risk of hormone-positive breast cancer.

The researchers concluded: “Breast cancer risk was not significantly associated with NSAID use, but daily aspirin use was associated with a modest reduction in ER-positive breast cancer. Our results provide support for further evaluating relationships by NSAID type and breast cancer subtype.”

Can Aspirin Prevent Breast Cancer Recurrence?

To explore the relationship between aspirin use and breast cancer outcomes, researchers conducted a study among more than 4,000 participants in the Nurses’ Health Study. The women included in the analysis had been diagnosed with Stage I-Stage III breast cancer between 1976 and 2002, and were observed until 2006.

Because women undergoing cancer treatment may need to avoid aspirin, information about aspirin use was not collected until at least one year after breast cancer diagnosis.

  • Compared with women who reported no aspirin use, risk of breast cancer death was reduced by 71% among women who used aspirin 2-5 times per week and by 64% among women who used aspirin 6-7 days per week. Risk of distant recurrence was also reduced among aspirin users.
  • The effect of aspirin on risk of distant recurrence and death did not appear to vary by cancer stage, menopausal status, body mass index, or estrogen receptor status.

These results suggest that among women living at least one year after a breast cancer diagnosis, regular aspirin use may reduce the risk of distant cancer recurrence and death. Because aspirin use carries some risks, however, women are advised to talk with their doctor before taking aspirin on a regular basis.

References

  1. Gierach G, Lacey J, Schatzkin A, et al. Nonsteroidal anti-inflammatory drugs and breast cancer risk in the National Institutes of Health-AARP Diet and Health Study. Breast Cancer Research [early online publication]. April 30, 2008. *DOI:*doi:10.1186/bcr2089.
  2. Takkouche B, Regueira-M?ndez C, Etminan M. Breast Cancer and Use of nonsteroidal anti-inflammatory drugs: a meta-analysis. Journal of the National Cancer Institute [early online publication]. October 2008. DOI: 10.1093/jnci/djn324.
  3. Holmes MD, Chen WY, Li L et al. Aspirin intake and survival after breast cancer. Journal of Clinical Oncology [early online publication]. February 16, 2010.

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