新資料證實每天一顆阿斯匹靈可降低癌症死亡率


  【24drs.com】一篇新研究結果支持每天使用阿斯匹靈,以幫助預防死於癌症。不過,美國癌症協會(ACS)的Eric J. Jacobs醫師表示,對於可能的效益有多大,仍有疑問。
  
  Jacobs醫師表示, 其研究動機是,最近有一篇分析彙整了現有的每日服用阿斯匹靈預防心血管事件的結果,發現服用阿斯匹靈5年以上者,其癌症死亡率估計降低了37%[Lancet. 2012;379:1602–1612]。
  
  但是還不確定每天使用多少量的阿斯匹靈可降低癌症死亡率。那篇彙整分析的樣本數有限,兩篇相當大型之隔天服用阿斯匹靈的隨機試驗發現對於整體癌症死亡率沒有效果。
  
  為了釐清每天服用多少劑量阿斯匹靈可降低癌症死亡率風險,Jacobs醫師等人分析了「Cancer Prevention Study II Nutrition Cohort」研究,於問卷中表示有使用阿斯匹靈之100,139名年長者的資料。
  
  研究線上刊載於8月10日的美國國家癌症研究院期刊。
  
  這些研究對象在研究開始時沒有癌症,追蹤期最長達11年;研究者發現,包括每天服用阿斯匹靈至少5年或短期每天使用者,每天使用阿斯匹靈與癌症死亡率整體風險降低16%有關。
  
  整體癌症死亡率降低,主要是胃腸道癌症(例如食道、胃與結腸直腸癌)比率降低約40%以及胃腸道之外的癌症降低約12%。
  
  Jacobs醫師表示,雖然最近有關使用阿斯匹靈和癌症的證據令人鼓舞,但仍不足以建議人們開始服用阿斯匹靈以預防癌症。
  
  他解釋,即使是低劑量阿斯匹靈也可能會顯著增加嚴重胃腸道出血風險;有關使用阿斯匹靈的決定,應考慮個人病史而衡量風險,必須和健康照護專業人士諮商後才可以做決定。
  
  他指出,專家委員會發展臨床指引、更新阿斯匹靈使用指引時將考量風險與利益的整體證據。
  
  Jacobs醫師希望這篇研究和最近其他有關阿斯匹靈的效益研究,將可更深入探討每天使用和長期使用阿斯匹靈,以更清楚暸解阿斯匹靈對特定癌症的效果。
  
  北卡羅來納大學醫學院的John A. Baron醫師在編輯評論中指出,整體而言,這篇進行良好的ACS研究呼應了有關阿斯匹靈和癌症死亡率的其他資料,但是沒有明確確認。
  
  他指出,使用阿斯匹靈和癌症的宏觀面是相當正面的,這項藥物的確降低了胃腸腔炎症的發生率和死亡率,對其他癌症也可能有類似影響。「只要吃一顆藥就可能可以預防癌症發生和死亡」,這是令人興奮的。
  
  不過,就像Jacobs醫師所說的,Baron醫師呼籲,對於建議使用阿斯匹靈以預防癌症要謹慎。
  
  他表示,阿斯匹靈有效並不意味著是否必要使用;阿斯匹靈確實是有毒性的一種藥物,至於預防性介入,必須衡量利益與風險,特別是效益比風險更低或更慢發生時。
  
  資料來源: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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