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【商业翻译】(医师报约稿)Long-Term Adult-Strength A
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Long-Term Adult-Strength Aspirin Use May Reduce Overall Cancer Incidence
April 24, 2007 — Adult-strength aspirin taken daily for 5 years or more was associated with a 15% reduced overall cancer incidence, according to the results of a large cohort study reported in the April 18 issue of the Journal of the National Cancer Institute.
"Epidemiologic evidence indicates that aspirin use is associated with reduced risks of colon cancer and possibly several other cancers, including prostate and breast cancers," write Eric J. Jacobs, PhD, from the American Cancer Society in Atlanta, Georgia, and colleagues. "Recent results from the Women's Health Study randomized trial indicate that long-term use of low-dose aspirin (100 mg every other day) does not substantially reduce cancer risk. However, the potential effect of long-term daily use of higher doses of aspirin on cancer incidence remains uncertain."
The investigators determined associations between long-term daily use of adult-strength aspirin (≥ 325 mg/day) and overall cancer incidence, as well as incidence of 10 types of cancer in 69,810 men and 76,303 women participating in the Cancer Prevention Study II Nutrition Cohort, a relatively elderly population. Information on aspirin use was collected at enrollment in 1992 - 1993 and updated in 1997, 1999, and 2001. Rate ratios (RRs) were determined from multivariable Cox proportional hazards regression.
Through follow-up ending in June 2003, cancer was diagnosed in 10,931 men and 7196 women. Compared with no use, daily use of adult-strength aspirin for 5 years or more was associated with lower overall cancer incidence in men (multivariable-adjusted RR, 0.84; 95% confidence interval [CI], 0.76 - 0.93) and non–statistically significant lower overall cancer incidence in women (multivariable-adjusted RR, 0.86; 95% CI, 0.73 - 1.03).
After standardization to the age distributions of men and women in the study, overall cancer incidence per 100,000 person-years with long-term daily aspirin use and no aspirin use was 1858 and 2163, respectively, among men, and 1083 and 1169, respectively, among women. Long-term daily aspirin use was linked to reduced incidence of colorectal cancer (RR, 0.68; 95% CI, 0.52 - 0.90; among men and women combined) and prostate cancer (RR, 0.81; 95% CI, 0.70 - 0.94) and a non–statistically significant lower risk for female breast cancer (RR, 0.83; 95% CI, 0.63 - 1.10).
"Long-term daily use of adult-strength aspirin may be associated with modestly reduced overall cancer incidence in populations among whom colorectal, prostate, and breast cancers are common," the authors write.
Study limitations include observational design subject to confounding, lack of data on potentially harmful effects from daily long-term use of adult-strength aspirin, insufficient statistical power to examine long-term daily use of low-dose aspirin, and lack of generalizability to other populations.
"Confirmation from randomized trials is necessary before a reduction in cancer risk could be considered a benefit of using adult-strength aspirin," the authors conclude. "Our results indicate that a randomized trial examining the effect of aspirin on cancer incidence would need to be both large and long term, probably lasting a minimum of 10 years.... If daily adult-strength aspirin use is ultimately found to meaningfully reduce overall cancer risk, there could be important clinical implications with respect to who should be taking aspirin and at what dose."
The American Cancer Society funded this study.
J Natl Cancer Inst. 2007;99:608-615.
Clinical Context
According to the authors of the current study, a recent 10-year randomized prospective trial of alternate-day, low-dose (100-mg) aspirin use in women showed no protective effect against cancer in women, but other trials of aspirin have shown protection against colorectal cancer, and the effect of long-term adult-strength aspirin use on cancer incidence is not known. Because aspirin is used for cardiovascular protection but has gastrointestinal bleeding as an adverse effect, information about its role in cancer protection would aid clinical decision making when considering benefits vs risks.
This is a large cohort study of men and women within the Cancer Prevention Study II Nutrition Cohort observed for 10 years to examine the impact of daily adult-strength aspirin use on cancer risk.
Study Highlights
Included were men and women from a cohort of 86,404 participants in a prospective cancer incidence and mortality study, followed up from 1992 - 1993 for 10 years.
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作者:admin@医学,生命科学 2011-03-04 17:12
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