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Strong release on aspirin and reduced cancer risk cancer study needed a few more qualifiers

Taking aspirin could increase cancer survival by 20 percent

Our Review Summary

aspirinAspirin is one of the most well-studied drugs on the planet, in terms of treating headaches, aches, and pains as well as in helping out those who are at risk of heart disease — the biggest killer of people in developed nations. This release promotes a study that looks at the common drug’s effect on the second-biggest killer, which is cancer.

The meta-analysis crunched the data of five randomized trials and 42 smaller studies that focused on colorectal, prostate, and breast cancers and — most importantly — the effect of a low-dose aspirin regimen on the survival of those patients, as well as how their cancer spread over a period of about 5 years.

The correlation is eyebrow-raising, with a reduction in death and cancer spread in the neighborhood of about 20%.

On the downside, this release doesn’t really get into what might be causing this reduction, or even define what “low-dose aspirin” means. It also doesn’t adequately discuss the risks (e.g. bleeding, allergies, and stomach ulcers) and skips over a couple of other basics that would have been helpful to journalists and readers alike.

 

Why This Matters

Behind heart disease, cancer is the biggest killer of people in developed nations. Each year the disease kills about 176 in every 100,000 people in the UK, and roughly 171 in every 100,000 people in the US. Any treatment that that can improve survival — especially low-cost, non-invasive methods — deserves attention.

Aspirin is one of the best-studied drugs on the planet, and its risks and side effects are as well known as a preventative treatment for people who are at risk of heart disease, or who’ve had strokes or heart attacks before.

Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) have been studied for use in the prevention of cancer. The best data exists for low-dose aspirin and colorectal cancer prevention. The US Preventative Task Force released a final recommendation in April 2016 suggesting certain adults (ages 50-59) might reduce their risk of developing both colorectal cancer and cardiovascular disease if they undertake long-term use (10 years) of low-dose aspirin. The current study examines whether aspirin could improve survival among patients who already have cancer. The authors suggest benefit but admit that the data is limited and mainly comes from observational studies.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Applicable

The release doesn’t touch on cost but because aspirin is so widely available, and its cost so minimal, we’ll mark this one “not applicable.”

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

We’re told that, during a given span of 5 years, a low-dose aspirin regimen in a patient with colorectal, prostate, or breast cancer is associated with a 15-20% reduction in death and spread of cancer. We generally want to see absolute (actual number of patients or volunteers) as well as relative risk reduction numbers. However, the study only provides relative risk data. Nevertheless, we think it’s incumbent upon news release writers to present benefits data in terms that are meaningful for readers. And if those results aren’t included in the study being described, news release writers should press their sources for more detailed and complete information.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The only risk of harm in the release is a passing mention of intestinal bleeding in cases of colorectal cancer.

Briefly mentioning the handful of other risks would have greatly improved this release. Even small doses (80-325 mg) of aspirin can reduce the body’s ability to clot wounds, and consequently promote bleeding. Giving aspirin to patients being treated for cancer may be presumed to increase bleeding risk, especially if the patient has low platelets as a result of chemotherapy.

Some people are also allergic to aspirin, which can complicate asthma. A regular dose of aspirin can also increase the risk of bleeding stomach ulcers.

Importantly, 21 out of 36 studies included in the meta-analysis of aspirin and the three cancer types had no data on bleeding.

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

We appreciated the fairness of the release. In addition to highlighting the correlation in better survival with low-dose aspirin, it also called out its weaknesses. Those included a lack of important data (e.g. on bleeding) and a need for new, randomized trials to test their hypothesis.

We found the cause-and-effect language (“could increase survival”) used was inappropriate for a study whose conclusions are based almost entirely on observational studies.

The release also doesn’t make clear when the aspirin is to be used. Is it during active treatment of the cancer with chemotherapy? Is it after the primary treatment is provided? One could imagine concern with using aspirin in regimens associated with bone marrow suppressing effects. The implication is that this should be part of standard cancer treatment, but not enough information is provided to make it clear.

In reviewing the published study, there are comments about how it was hard to perform the analyses due to differences among studies. Given the statements in the release about patients using this evidence to decide on the role for using aspirin as part of cancer treatment, we think that that these additional details should be provided.

Does the news release commit disease-mongering?

Satisfactory

We didn’t see any evidence of stoking fears about disease; the language is grounded and straightforward.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

Funding sources and potential conflicts of interest weren’t noted in the release. The study, published in PLoS ONE,  however, declares no conflicts of interest and — curiously — no support or funding, either.

But since this type of study is based on analyzing others’ results, we’ll go out on a limb to assume that the researchers’ institutions backed it in the form of their usual salaries. In any case, we want to see these items clarified in news releases.

Does the news release compare the new approach with existing alternatives?

Satisfactory

The alternative approach to going on a low-dose regimen of aspirin — i.e. not doing so — is assumed but not made clear. But we’ll award points to the release for smartly quoting one of the study authors on seeking out the advice of a doctor before taking aspirin regularly.

Does the news release establish the availability of the treatment/test/product/procedure?

Not Applicable

The release doesn’t address availability but we know aspirin is available in pretty much any convenience store on Earth. We’ll rate this “not applicable.”

Does the news release establish the true novelty of the approach?

Satisfactory

The release makes an indirect claim of novelty by summarizing the research as an effort to look at “its role in the treatment of cancer.” The novelty of the work is pretty clear: Take a whole bunch of smaller studies and, through strength in numbers and careful analysis, see how low-dose aspirin might help or hinder cancer patients. And the number that emerges is impressive. While aspirin and other NSAIDs have been proposed for use in cancer prevention, especially colon cancer, use as a treatment for cancer itself is novel.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Satisfactory

We didn’t see anything glaring in the body of the release. The headline: “Taking aspirin could increase cancer survival by 20 percent” captures attention but might have been more faithful to the study by making it clear than only a correlation was found between aspirin and lowered cancer risk.

Total Score: 4 of 8 Satisfactory

Comments (3)

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Pprofessor Peter Elwood

April 27, 2016 at 3:06 pm

“We generally want to see absolute (actual number of patients or volunteers) as well as relative risk reduction numbers. ”
Actual numbers of patients on aspirin, and of patients not on aspirin are given in the tables

‘The only risk of harm in the release is a passing mention of intestinal bleeding in cases of colorectal cancer’.
The ‘passing reference’ to bleeding in the paper was based on personal correspondence with the authors of 37 of the studies. Elsewhere we, and others have discussed bleeding attributable to aspirin in detail, we felt that what we stated was adequate in the context of the report.

‘We found the cause-and-effect language (“could increase survival”) used was inappropriate for a study whose conclusions are based almost entirely on observational studies.’
The phrase ‘could increase survival’ is of course a value judgement, and we felt that the consistency in the results of 47 studies by different research groups justified the phrase.

‘The release also doesn’t make clear when the aspirin is to be used. Is it during active treatment of the cancer with chemotherapy? Is it after the primary treatment is provided? One could imagine concern with using aspirin in regimens associated with bone marrow suppressing effects. The implication is that this should be part of standard cancer treatment, but not enough information is provided to make it clear.’
We make it clear that aspirin is a possible additional treatment, and the various reports in our review mention a variety of treatments, but none describe any interaction, or gave any warning about possible harmful interactions.

‘Funding sources and potential conflicts of interest weren’t noted in the release. The study, published in PLoS ONE, however, declares no conflicts of interest and — curiously — no support or funding, either. But since this type of study is based on analyzing others’ results, we’ll go out on a limb to assume that the researchers’ institutions backed it in the form of their usual salaries. In any case, we want to see these items clarified in news releases’.
Let me (PCE), as the lead author and by far the main contributor to the work, answer this last comment. I retired a number of years ago and I received no payment, or expenses, or honorarium of any kind for the work which let to the paper. The other authors gave of their time, which represents fundimg by Cardiff University. No pharmaceutical company, or any group with a vested interest, had any involvement whatever in the work.

Reply

    Steven Atlas, MD, MPH

    April 28, 2016 at 10:01 am

    We appreciate the author’s comments and recognize that information provided in the manuscript itself may address some of our concerns. However, we were reviewing the press release and not the manuscript itself. Our goal is to highlight where the release did a good job and where it could do better. This is not the primarily the responsibility of the manuscript author, but rather the press department that did the release. While we recognize that the release is intended to draw attention to the study itself, it can do so in a manner that does not go beyond what the data itself supports. As a practicing physician, when I’m working with oncologists to treat my patients with active cancer, aspirin isn’t one of the things we’re thinking about much. However, for patients at high risk for a colon cancer they do not yet have or maybe for someone who has completed primary treatment for colon cancer, aspirin is something I may talk about with the patient. As such, this press release brings it to my attention. But mainly it reminds me that more research is needed to see if the benefits exceed the known risks.

    Reply

Dave Mosher

April 27, 2016 at 8:05 pm

Thanks for your comment, Dr. Elwood. We really appreciate the detailed responses to our press release evaluation. Speaking of which, it’s important to make that distinction clear: Although Health News Review contributors look to a study for verification or answers, and bring those relevant details to light in our reviews, our critique is aimed at the press release or news story itself, not the study proper.

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