By Thea Jourdan
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Humble aspirin, the staple of every medicine cabinet, is proving to be a remarkable drug.
Originally derived from willow bark, but now synthetically made, it’s been used as a painkiller for years.
It’s also widely taken by people with cardiovascular disease or at risk of stroke due to its ability to cut the risk of blood clots.
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| Research published last week in The Lancet found taking a daily low-dose aspirin for five years cut cancer death risk by 37 per cent |
Most recently, research published last week in The Lancet found taking a daily low-dose aspirin for five years cut cancer death risk by 37 per cent.
The drug appeared to stop the disease spreading and to ward off certain types of cancer, such as colon and breast.
How does aspirin work against cancer?
Opinion is divided but it appears either to block the release of growth factors (compounds that stimulate cancer cell growth) or cause cancer cells to die by affecting their repair system.
Given this latest evidence, should we all be popping a daily aspirin?
The downside is that aspirin carries the risk of stomach ulcers and internal bleeding, and so the general rule is only to take a daily aspirin on the advice of your doctor.
But is this outweighed by the benefits?
There are calls for the government watchdog, the National Institute for Health and Clinical Excellence, to issue guidelines on whether the drug should be used more widely.
In the meantime, what do doctors think — are they themselves taking a low-dose aspirin?
THE ASPIRIN RESEARCHER
Peter Rothwell, 47, professor of clinical neurology at the University of Oxford, was the lead author of the latest studies that suggest aspirin has cancer-fighting potential. He says:
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| Aspirin is widely taken by people with cardiovascular disease |
As a father of three young daughters all aged under ten, I look after my health, and taking a daily aspirin is an important part of this.
I take a low-dose pill, which is equivalent to a so-called junior aspirin (75mg a day rather than the usual pain-killing dose of 300mg). I’ve been doing this for years.
I know about the possible side-effects, but the evidence suggests the advantages of taking aspirin are greater than the disadvantages in my case.
I don’t have a history of indigestion, which would otherwise make me more susceptible to gastrointestinal bleeding.
The risk of a bleed reduces if someone has been taking aspirin for three years anyway, probably because those at risk have already stopped taking the pill by then.
Cancer becomes more common in people aged 50 and over, and so it might make sense to start taking aspirin as a preventative treatment in the late 40s, and to stop at around 65, when the risk of bleeding increases.
I don’t want to suggest that people rush out and buy aspirin, but I think it’s at least worth thinking about for healthy, middle-aged people like me.
THE DRUG EXPERT
Professor David Webb, 58, is a clinical pharmacologist at the University of Edinburgh. He says:
I don’t take a daily dose of aspirin because I am yet to be convinced by the data. Professor Rothwell’s work is very interesting but other groups of researchers, independent of his team, need to repeat the work and confirm it is correct.
The possible downside is very real: gastrointestinal bleeding affects around 100 people in 100,000 taking aspirin. In rare cases, this can be devastating and life-threatening.
This is more common in older people, those with previous bleeds, and those with indigestion.
I have seen this for myself, and witnessed patients hospitalised with major bleeding after taking aspirin.
THE BOWEL SURGEON
Tim Rockall, 47, is a colorectal surgeon and professor of surgery at the Royal Surrey County Hospital. He says:
I don’t like popping pills — even vitamin pills — unless I have got very good reason, so no, I don’t take daily doses of aspirin. That said, this recent study has shown aspirin does seem to potentially reduce the growth of polyps in the colon, which can lead to cancer.
Before this, no one in colorectal circles put too much emphasis on aspirin as a preventative measure against colon cancer.
Even so, I remain to be convinced and, instead, I am putting my faith in the new national bowel cancer screening programme. I will definitely go for screening at the age of 60.
THE RESEARCH PIONEER
Professor Peter Elwood, a retired epidemiologist now in his 80s, was one of the first to look at the potential of aspirin for vascular disease. He says:I have been taking aspirin since 1974 when Professor Archie Cochrane and I published the results of our clinical trial that found patients who’d had a heart attack had a lower risk of dying if they took low-dose aspirin.
Taking aspirin was an easy decision for me.
There’s a profound difference between a stomach bleed, which is neither fatal nor leads to disablement, and a heart attack, a stroke or cancer, all of which have a high mortality and may lead to permanent disablement.
Of course, a stomach bleed is still unfortunate, but there is convincing evidence that stomach bleeds attributable to aspirin are not the most serious.
After 47 years of study into the subject, my conviction is that the risks and benefits of taking low-dose aspirin as a preventative should be told both to patients and to the healthy general public.
It’s then their decision whether to take the risk of a bleed in order to have the protection.
THE HEART SURGEON
Neil Roberts, 39, is a cardiac surgeon at The Heart Hospital at University College Hospital, London. He says:
As a cardiac surgeon, I use aspirin a lot in my practice, especially for patients who’ve undergone surgery because it can help reduce the risk of blood clots. There is also clear evidence that the benefits outweigh the risks in patients with cardiovascular disease.
But I wouldn’t take daily aspirin, due to the risk of gastrointestinal bleeding, and other known side-effects, such as hives and swelling of the tissues.
I need to see more evidence of benefits in healthy individuals before I’m convinced.
The reported studies in The Lancet were not trials in the general population; they were reviews of trials of aspirin in people with cardiovascular disease.
This means that they don’t provide evidence that blanket aspirin use in the general population carries more benefits than risks.
THE NHS GP
Louise Selby, 41, is based at a family practice in Guildford, Surrey. She says:Some of my patients have opted to take low-dose aspirin. I have occasionally tried to dissuade patients who I felt were unsuitable.
I don’t take low-dose daily aspirin myself because I don’t want to pop pills for no real reason, and I don’t have any risk factors for heart disease.
The most important thing is that people don’t start thinking taking a pill is a substitute for the things that matter — such as regular exercise and normal body weight.
THE PRIVATE GP
Dr Martin Scurr, 61, the Mail’s GP. He says:I don’t take aspirin. Yet I admit I’m slightly confused about aspirin’s benefits — some say it’s more dangerous to take aspirin than not to.
If it’s confusing for doctors like me, how confusing must it be for the public?
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