[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Cuzick  J, Thorat  MA, Bosetti  C,  et al.  Estimates of benefits and harms of prophylactic use of aspirin in the general population.  Ann Oncol. 2015;26(1):47-57. doi:10.1093/annonc/mdu225PubMedGoogle ScholarCrossref
Cuzick  J.  Preventive therapy for cancer.  Lancet Oncol. 2017;18(8):e472-e482. doi:10.1016/S1470-2045(17)30536-3PubMedGoogle ScholarCrossref
Algra  AM, Rothwell  PM.  Effects of regular aspirin on long-term cancer incidence and metastasis: a systematic comparison of evidence from observational studies versus randomised trials.  Lancet Oncol. 2012;13(5):518-527. doi:10.1016/S1470-2045(12)70112-2PubMedGoogle ScholarCrossref
Rothwell  PM, Wilson  M, Elwin  C-E,  et al.  Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials.  Lancet. 2010;376(9754):1741-1750. doi:10.1016/S0140-6736(10)61543-7PubMedGoogle ScholarCrossref
Shebl  FM, Hsing  AW, Park  Y,  et al.  Non-steroidal anti-inflammatory drugs use is associated with reduced risk of inflammation-associated cancers: NIH-AARP study.  PLoS One. 2014;9(12):e114633. doi:10.1371/journal.pone.0114633PubMedGoogle Scholar
Chan  AT, Giovannucci  EL, Meyerhardt  JA, Schernhammer  ES, Curhan  GC, Fuchs  CS.  Long-term use of aspirin and nonsteroidal anti-inflammatory drugs and risk of colorectal cancer.  JAMA. 2005;294(8):914-923. doi:10.1001/jama.294.8.914PubMedGoogle ScholarCrossref
Khalaf  N, Yuan  C, Hamada  T,  et al.  Regular use of aspirin or non-aspirin nonsteroidal anti-inflammatory drugs is not associated with risk of incident pancreatic cancer in two large cohort studies.  Gastroenterology. 2018;154(5):1380-1390.e5. doi:10.1053/j.gastro.2017.12.001PubMedGoogle ScholarCrossref
Cao  Y, Nishihara  R, Wu  K,  et al.  Population-wide impact of long-term use of aspirin and the risk for cancer.  JAMA Oncol. 2016;2(6):762-769. doi:10.1001/jamaoncol.2015.6396PubMedGoogle ScholarCrossref
Verdoodt  F, Friis  S, Dehlendorff  C, Albieri  V, Kjaer  SK.  Non-steroidal anti-inflammatory drug use and risk of endometrial cancer: a systematic review and meta-analysis of observational studies.  Gynecol Oncol. 2016;140(2):352-358. doi:10.1016/j.ygyno.2015.12.009PubMedGoogle ScholarCrossref
Cook  NR, Lee  I-M, Gaziano  JM,  et al.  Low-dose aspirin in the primary prevention of cancer: the Women’s Health Study: a randomized controlled trial.  JAMA. 2005;294(1):47-55. doi:10.1001/jama.294.1.47PubMedGoogle ScholarCrossref
Whitlock  EP, Williams  SB, Burda  BU, Feightner  A, Beil  T.  Aspirin Use in Adults: Cancer, All-Cause Mortality, and Harms: A Systematic Review of the Evidence for the Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality; 2015.
Bibbins-Domingo  K; US Preventive Services Task Force.  Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: US Preventive Services Task Force Recommendation Statement.  Ann Intern Med. 2016;164(12):836-845. doi:10.7326/M16-0577PubMedGoogle ScholarCrossref
McNeil  JJ, Woods  RL, Nelson  MR,  et al; ASPREE Investigator Group.  Effect of aspirin on disability-free survival in the healthy elderly.  N Engl J Med. 2018;379(16):1499-1508. doi:10.1056/NEJMoa1800722PubMedGoogle ScholarCrossref
McNeil  JJ, Nelson  MR, Woods  RL,  et al; ASPREE Investigator Group.  Effect of aspirin on all-cause mortality in the healthy elderly.  N Engl J Med. 2018;379(16):1519-1528. doi:10.1056/NEJMoa1803955PubMedGoogle ScholarCrossref
Andriole  GL, Crawford  ED, Grubb  RL  III,  et al; PLCO Project Team.  Prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: mortality results after 13 years of follow-up.  J Natl Cancer Inst. 2012;104(2):125-132. doi:10.1093/jnci/djr500PubMedGoogle ScholarCrossref
Prorok  PC, Andriole  GL, Bresalier  RS,  et al; Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial Project Team.  Design of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.  Control Clin Trials. 2000;21(6)(suppl):273S-309S. doi:10.1016/S0197-2456(00)00098-2PubMedGoogle ScholarCrossref
National Cancer Institute.  Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial supplemental questionnaire. https://cdas.cancer.gov/datasets/plco/91/. Accessed March 8, 2019.
National Cancer Institute.  Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial baseline questionnaire. https://cdas.cancer.gov/datasets/plco/90/. Accessed March 8, 2019.
Pinsky  PF, Prorok  PC, Yu  K,  et al.  Extended mortality results for prostate cancer screening in the PLCO trial with median follow-up of 15 years.  Cancer. 2017;123(4):592-599. doi:10.1002/cncr.30474PubMedGoogle ScholarCrossref
World Health Organization.  International Classification of Diseases, Ninth Revision (ICD-9). Geneva, Switzerland: World Health Organization; 1977.
Chubak  J, Whitlock  EP, Williams  SB,  et al.  Aspirin for the prevention of cancer incidence and mortality: systematic evidence reviews for the US Preventive Services Task Force.  Ann Intern Med. 2016;164(12):814-825. doi:10.7326/M15-2117PubMedGoogle ScholarCrossref
Rothwell  PM, Fowkes  FGR, Belch  JFF, Ogawa  H, Warlow  CP, Meade  TW.  Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials.  Lancet. 2011;377(9759):31-41. doi:10.1016/S0140-6736(10)62110-1PubMedGoogle ScholarCrossref
Albandar  HJ, Markert  R, Agrawal  S.  The relationship between aspirin use and mortality in colorectal cancer.  J Gastrointest Oncol. 2018;9(6):1133-1137. doi:10.21037/jgo.2018.08.13PubMedGoogle ScholarCrossref
Jacobs  EJ, Newton  CC, Gapstur  SM, Thun  MJ.  Daily aspirin use and cancer mortality in a large US cohort.  J Natl Cancer Inst. 2012;104(16):1208-1217. doi:10.1093/jnci/djs318PubMedGoogle ScholarCrossref
Chan  AT, Gibbs  P, Orchard  S,  et al.  Effect of initiating aspirin on cancer events in the healthy elderly: primary results from the ASPREE randomized controlled trial [AGA abstract 400a].  Gastroenterology. 2019;156(6):S78-S79. doi:10.1016/S0016-5085(19)36983-5Google ScholarCrossref
Chan  AT, McNeil  J.  Aspirin and cancer prevention in the elderly: where do we go from here?  Gastroenterology. 2019;156(3):534-538. doi:10.1053/j.gastro.2018.11.063PubMedGoogle ScholarCrossref
Huang  WY, Daugherty  SE, Shiels  MS,  et al.  Aspirin use and mortality in two contemporary US cohorts.  Epidemiology. 2018;29(1):126-133. doi:10.1097/EDE.0000000000000746PubMedGoogle ScholarCrossref
Campbell  PT, Newton  CC, Dehal  AN, Jacobs  EJ, Patel  AV, Gapstur  SM.  Impact of body mass index on survival after colorectal cancer diagnosis: the Cancer Prevention Study-II Nutrition Cohort.  J Clin Oncol. 2012;30(1):42-52. doi:10.1200/JCO.2011.38.0287PubMedGoogle ScholarCrossref
Wang  X, Chan  AT, Slattery  ML,  et al.  Influence of smoking, body mass index, and other factors on the preventive effect of nonsteroidal anti-inflammatory drugs on colorectal cancer risk.  Cancer Res. 2018;78(16):4790-4799. doi:10.1158/0008-5472.CAN-18-0326PubMedGoogle ScholarCrossref
Ratnasinghe  LD, Graubard  BI, Kahle  L, Tangrea  JA, Taylor  PR, Hawk  E.  Aspirin use and mortality from cancer in a prospective cohort study.  Anticancer Res. 2004;24(5B):3177-3184.PubMedGoogle Scholar
Movahedi  M, Bishop  DT, Macrae  F,  et al.  Obesity, aspirin, and risk of colorectal cancer in carriers of hereditary colorectal cancer: a prospective investigation in the CAPP2 study.  J Clin Oncol. 2015;33(31):3591-3597. doi:10.1200/JCO.2014.58.9952PubMedGoogle ScholarCrossref
Afshin  A, Forouzanfar  MH, Reitsma  MB,  et al; GBD 2015 Obesity Collaborators.  Health effects of overweight and obesity in 195 countries over 25 years.  N Engl J Med. 2017;377(1):13-27. doi:10.1056/NEJMoa1614362PubMedGoogle ScholarCrossref
Bhatt  DL, Grosser  T, Dong  JF,  et al.  Enteric coating and aspirin nonresponsiveness in patients with type 2 diabetes mellitus.  J Am Coll Cardiol. 2017;69(6):603-612. doi:10.1016/j.jacc.2016.11.050PubMedGoogle ScholarCrossref
Patrono  C, Rocca  B.  Type 2 diabetes, obesity, and aspirin responsiveness.  J Am Coll Cardiol. 2017;69(6):613-615. doi:10.1016/j.jacc.2016.11.049PubMedGoogle ScholarCrossref
Basili  S, Pacini  G, Guagnano  MT,  et al.  Insulin resistance as a determinant of platelet activation in obese women.  J Am Coll Cardiol. 2006;48(12):2531-2538. doi:10.1016/j.jacc.2006.08.040PubMedGoogle ScholarCrossref
Cryer  B.  Reducing the gastrointestinal risks of low-dose aspirin.  Gastroenterology. 2010;138(1):30-33. doi:10.1053/j.gastro.2009.11.032PubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    2 Comments for this article
    Aspirin should not substitute life style modification
    Kamran Lankarani, Professor of Medicine | Shiraz University of Medical Sciences, Iran
    Although the importance of use of ASA as a secondary preventive measure specially in cardiovascular disease has been well documented , there are controversial reports of its use as a primary preventive measure specially in elderly.(1) The possibility of death due to gastrointestinal or intracerebral hemorrhage is a real threat specially in this age group . While the reduced mortality from cancer specially colorectal cancer needs 5 to 8 years to be achieved, the risk of major bleeding is there from the beginning. (2)
    I read with interest the article by Loomans-Kropp and her colleagues to get an answer
    for this important question. (3) Unfortunately I found several obscured points which makes conclusion difficult. As this cohort were not randomized on receiving ASA, the direct effect of ASA could be due to confounders. For instance those who use ASA as a primary preventive measure may have more concerns about their health which may also lead to more healthier life style.This may confound the effect of ASA as a primary reason for reduced mortality .
    Some information on covariates are presented in supplement. All cause mortality, mortality from cancers and gastrointestinal cancers except for colorectal cancer were higher in those with body mass index of less than 20 even compared to overweight and obese persons. This is in contrast to the well established effect of obesity and overweight as a risk factor for all cause mortality and cancer mortality. The authors did not provide any explanation for this odd finding. Interestingly this group did not show any benefit with usage of ASA. Of interest there is no information on ethanol usage. There is possibility of contribution of effect of ethanol on this finding.
    In conclusion one important drawback of these type of studies is medicalization of public health and ignorance the importance of life style modification while exposing population to unwanted hazards of drugs even old drugs like ASA.

    1. McNeil JJ, Wolfe R, Woods RL, Tonkin AM, Donnan GA, Nelson MR, et al. Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. New England Journal of Medicine. 2018;379(16):1509-18.
    2. B Lankarani K. Aspirin for the Primary Prophylaxis of Colorectal Cancer. Annals of Colorectal Research. 2013;1(3):7-8.
    3. Loomans-Kropp HA, Pinsky P, Cao Y, Chan AT, Umar A. Association of Aspirin Use With Mortality Risk Among Older Adult Participants in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. JAMA Network Open. 2019;2(12):e1916729-e.
    BMI association not clear
    Jim Hendricks, Prof. (Kinesiology/Adptn) | Chicago State University
    I'm unclear of the correlation of ASA use in elderly persons with BMI > 20, especially the correlation of all cause mortality (in addition to the cancers outlined in the article). Is the issue of gastrointestinal and cerebral hemorrhage outweighed by ASA use in the elderly (3 times weekly or more)?
    Original Investigation
    Public Health
    December 4, 2019

    Association of Aspirin Use With Mortality Risk Among Older Adult Participants in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

    Author Affiliations
    • 1Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
    • 2Gastrointestinal and Other Cancers Branch, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
    • 3Early Detection Research Branch, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
    • 4Siteman Cancer Center, Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
    • 5Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston
    • 6Division of Gastroenterology, Massachusetts General Hospital, Boston
    • 7Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
    • 8Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
    JAMA Netw Open. 2019;2(12):e1916729. doi:10.1001/jamanetworkopen.2019.16729
    Key Points español 中文 (chinese)

    Question  Is aspirin use associated with reduced risk of mortality in older adults?

    Findings  This cohort study included 146 152 individuals from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial and found that aspirin use 3 or more times per week was associated with reduced risk of all-cause, cancer, gastrointestinal cancer, and colorectal cancer mortality.

    Meaning  These findings suggest that prophylactic aspirin use may reduce risk of mortality among older individuals.


    Importance  Aspirin use has been associated with reduced risk of cancer mortality, particularly of the colorectum. However, aspirin efficacy may be influenced by biological characteristics, such as obesity and age. With the increasing prevalence of obesity and conflicting data regarding the effect of aspirin in older adults, understanding the potential association of aspirin use with cancer mortality according to body mass index (BMI) and age is imperative.

    Objectives  To investigate the association of aspirin use with risk of all-cause, any cancer, gastrointestinal (GI) cancer, and colorectal cancer (CRC) mortality among older adults and to perform an exploratory analysis of the association of aspirin use with mortality stratified by BMI.

    Design, Setting, Participants  This cohort study evaluated aspirin use among participants aged 65 years and older in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial at baseline (November 8, 1993, to July 2, 2001) and follow-up (2006-2008). Analysis began in late 2018 and was completed in September 2019.

    Main Outcomes and Measures  All-cause, any cancer, GI cancer, or CRC mortality. Multivariable hazard ratios (HRs) and 95% CIs were calculated using time-varying Cox proportional hazards regression modeling, adjusting for additional factors.

    Results  A total of 146 152 individuals (mean [SD] age at baseline, 66.3 [2.4] years; 74 742 [51.1%] women; 129 446 [88.6%] non-Hispanic white) were included in analysis. The median (interquartile range) follow-up time was 12.5 (8.7-16.4) years, encompassing 1 822 164 person-years. Compared with no use, aspirin use 1 to 3 times per month was associated with reduced risk of all-cause mortality (HR, 0.84; 95% CI, 0.80-0.88; P < .001) and cancer mortality (HR, 0.87; 95% CI, 0.81-0.94; P < .001). Aspirin use 3 or more times per week was associated with decreased risk of mortality of all causes (HR, 0.81; 95% CI, 0.80-0.83; P < .001), any cancer (HR, 0.85; 95% CI, 0.81-0.88; P < .001), GI cancer (HR, 0.75; 95% CI, 0.66-0.84; P < .001), and CRC (HR, 0.71; 95% CI, 0.61-0.84; P < .001). When stratified by BMI (calculated as weight in kilograms divided by height in meters squared), aspirin use 3 or more times per week among individuals with BMI 20 to 24.9 was associated with reduced risk of all-cause mortality (HR, 0.82; 95% CI, 0.78-0.85; P < .001) and any cancer mortality (HR, 0.86; 95% CI, 0.79-0.92; P < .001). Among individuals with BMI 25 to 29.9, aspirin use 3 or more times per week was associated with reduced risk of all-cause mortality (HR, 0.82; 95% CI, 0.79-0.85; P < .001), any cancer mortality (HR, 0.86; 95% CI, 0.81-0.91; P < .001), GI cancer mortality (HR, 0.72; 95% CI, 0.60-0.86; P < .001), and CRC mortality (HR, 0.66; 95% CI, 0.51-0.85; P = .001).

    Conclusions and Relevance  In this cohort study, aspirin use 3 or more times per week was associated with a reduction in all-cause, cancer, GI cancer and CRC mortality in older adults.