From the appropriate title to the last precautionary sentence, this story provides the readers with a balanced perspective and places the study into context. This story gives readers key facts and a range of expert reactions and context about a study that re-analyzed heart disease prevention experiments and saw lower rates of cancer deaths among trial participants who had been assigned to take daily low-dose aspirin. Readers are clearly told that while this study provides new insight, there are some key questions that need to be answered before many experts would change their recommendations about aspirin. The only important shortcoming is that it reports only the relative risk reductions without also telling readers about the absolute differences in cancer death rates that the researchers observed.
Cancers of all types are second only to heart disease as the cause of death in developed countries. A number of observational studies have suggested that the kind of low-dose aspirin regimen recommended for some people at risk of heart disease may also have some cancer-related benefits. This study attempts to avoid some of the inherent limitations of observational studies by using data that was collected as part of experimental trials that randomized people to take aspirin or a placebo pill. It is important that stories explain both the advantages and limitations of this kind of data analysis.
Although the story does not discuss costs, the price of aspirin is low and well-known. Yet it would be helpful for stories about population-wide recommendations to address total costs, even if the price for individuals seems low. Broader use of aspirin would also inevitably lead to an increase in the costs of treating bleeding ulcers and other adverse events and they should be acknowledged, even if there might be offsetting reductions in other treatment expenses.
Like many other reports, this story relied exclusively on relative risk reduction. Overall the study noted a 3% incidence of cancer in participants who did not receive aspirin and a 2.3% incidence for those who took aspirin. Yes, that is a 23% reduction overall but a 0.7% absolute reduction. Put another way, if indeed aspirin is preventive, you would need to treat 150 people to prevent one occurence of cancer. That benefit needs to be put into context because aspirin is not without its side effects. Nevertheless, we are rating this as satisfactory despite the use of relative risk based, because it did not trumpet the relative risk reductions and emphasized the uncertainties and limitations of the study results.
In contrast to some other stories we reviewed, from the lead sentence through the body of the story, it is clear that aspirin increases the risk of bleeding ulcers and other bleeding problems.
The story includes a description of the key features of the study, noting that the researchers re-analyzed data from several experiments that compared the heart disease outcomes of people randomly assigned to take aspirin daily to those who were given placebo pills, and that the researchers then added in data from death records in order to asses long-term cancer death rates. The story highlights concerns about relying on data gathered to look at one health threat (heart disease) in order to draw conclusions about a completely different health threat (cancer).
It is difficult to mention cancer and not fall victim to disease mongering. Few other disease provide a similar emotional response. The story highlights questions about who might receive some cancer-reduction benefit, noting that the data used for this study included very few women and that since the underlying trials were designed to look for heart disease effects and not cancer, there may be things about the participants that would affect the results, but weren’t recorded during the original trials. These caveats help make clear that there are still uncertainties about who exactly might benefit.
The story includes comments from several independent sources and cites current guidelines that do not recommend trying to use aspirin to reduce cancer risk. The story also specifically notes that while the researchers did not get outside funding for this study, several of the authors have been paid consultants to pharmaceutical companies.
The story not only highlights comments from those who say it is too early to recommend aspirin as a way to reduce cancer risk, it includes a comment recommending keeping a healthy body weight and not smoking in order to prevent cancer.
The availability of aspirin is well-known. Indeed it is so common as to be often perceived as innocuous. Since readers may take aspirin without consulting a health care professional, stories about aspirin should clearly distinguish between those uses that a well-supported by evidence and those that require further evaluation. The story points out that certain people already take low-dose aspirin because of heart disease concerns. The context and cautions included in this story are a welcomed departure from some other stories we reviewed.
The story notes that this study adds to previous research that has looked at the potential cancer-related effects of aspirin.
The story does not appear to rely on a news release.