
Aspirin could dramatically cut cancer risk, according to biggest study yet - wslh
http://www.theguardian.com/science/2014/aug/06/aspirin-could-dramtically-cut-cancer-risk-say-scientists-biggest-study-yet
======
srean
This is one of the reasons why I want presence of governmental entities in
drug research. There is very little incentive for a private drug companies to
show that an el-cheapo generic drug that has had centuries of use (in some
form or the other) behind it, can counter some serious diseases. Yes new use
can be patented, but its really impractical to enforce. Sort of like those
allergy drugs and sleeping aids, same exact composition but placed in
different aisles with different names and grossly different prices. As much as
I love the market, sometimes it is either insufficient, or works way too slow
for a human lifetime.

[Digression: We either need a quantum increase in life-span, or a market force
catalyst that will speed up market dynamics few orders of magnitude, so that
the consequence of a market intervention affects the same guy who made that
intervention]

Back to aspirin, its really somewhat of a wonder-drug without a hype, if you
can stomach it that is.

~~~
TelmoMenezes
> There is very little incentive for a private drug companies to show...

Yes, but let's consider why:

1- Government regulation (patents) creates an artificial concept of property
that prevents humanity at large from benefiting from scientific advances that
could be much cheaper. The reasoning for patents is that they are a required
incentive from companies to go through expensive tests. But guess what...

2- It's government regulation that makes the tests so expensive.

So the government tries to solve a problem, then creates a new problem, then
tries to solve the new problem, then....

Every step seems reasonable and in the interest of the consumer, but the end
result is still that a majority of people do not have access the the level of
health care that is scientifically and technically possible, and not even
close. But at least they are protected from a number of things. Maybe.

We demand a high level of scientific rigor to accept a medication, but we
don't demand the same high level of scientific rigor to accept government
meddling. We just take it at face value that the benefits of regulation
outweigh the costs and this premise is never tested at large.

~~~
jusben1369
"We demand a high level of scientific rigor to accept a medication, but we
don't demand the same high level of scientific rigor to accept government
meddling" that seems like fairly rational behavior right given one could be
life threatening and one is a low level irritant that we feel like we can
address at the next ballot box if we feel so strongly?

~~~
CWuestefeld
_...and one is a low level irritant that we feel like we can address at the
next ballot box if we feel so strongly?_

But this is no longer true, for two reasons.

First, Congress has abdicated much of its power to regulatory agencies, which
are where the actual regulations' details are determined. These bodies are not
elected, so we can't vote them out. While it's true, in principle, that we
could use the ballot to get Congress to claw back its power, or at least to
influence the details, this would (a) take a really long time, and (b) is far
too broad a brush to paint with. Being able to cast one vote every 2 years for
my Representative, and one every six years for my Senator, is many orders of
magnitude too gross a control to be able to influence specific regulations
across the whole realm of governmental interest (suppose I hate the way the
FDA is handling one thing, but love the way that the DOT is doing something
else, etc.; how am I to influence all those factors with just two rare votes?)

Second, we're no longer able to determine with certainty what our government
is doing, in order to exercise control over it as necessary. For example, just
yesterday afternoon there was a story [1] on HN covering the government's
efforts to actually rewrite the records of a court proceeding, so that we
wouldn't know what had actually transpired in the court. And surely I don't
need to go into detail about Snowden, FISA courts, National Security Letters,
etc.

[1] [https://www.eff.org/deeplinks/2014/08/unsealed-us-sought-
per...](https://www.eff.org/deeplinks/2014/08/unsealed-us-sought-permission-
change-historical-record-public-court-proceeding)

------
XFrequentist
Aspirin's reduction of cancer risk has been on relatively solid
epidemiological footing for a long time, it's simply not a big enough
protective effect to balance the risk of bleeds etc:

[http://www.uspreventiveservicestaskforce.org/uspstf/uspsasco...](http://www.uspreventiveservicestaskforce.org/uspstf/uspsasco.htm)

Now, if you were to consider all cancers plus cardiovascular benefit, and
target folks who are more likely to benefit and/or less likely to have adverse
events, it might be useful. Trying to sort some of this out with genomic data
was the subject of my MSc, but I couldn't make it work.

~~~
Udo
I worked in biomedical research for a while and few things seem to trigger
controversies like Aspirin does. Many MDs believe it's evil and don't condone
its use for pretty much anything, but on the other end of the spectrum some
medical professionals seem to self-medicate with it religiously.

Personally, I've been taking it for many years, for many reasons. I am
genetically predisposed to colorectal cancer and serious cardiovascular
problems - both led to the death of many relatives and my father has been
battling both for a long time now.

Since my adolescence I've also been a migraine sufferer, which is where I
originally "discovered" Aspirin, because it helps lessen the impact like no
other substance and over the years I found that regular preventive usage
reduces the frequency of bad episodes to below 1/y, which is simply awesome.
It's probably important to mention that I got the stomach for it, too, which
is something that precludes many people from taking it on a regular basis.

With my anecdotal history in mind and weighing my person risk factors against
the known complications (I dread ever being in a serious accident where blood
loss becomes an issue), I have elected to take it every day.

Pharmacists are horrified, by the way. "Don't take it for longer than 3 days!"
"Wouldn't you prefer Ibu instead? You should."

~~~
atmosx
Aspirin's action (activation etc) is well defined at chemical level. Of
course, we probably don't know the entire pharmacokinetic/pharcodynamc action
of the drug. But if the patient is not on other drugs that could interact with
aspirin (e.g. anticoagulants, β2-blockers, antihypertensives, etc.) why not
take half if not one aspirin per day?

Depends on the organism, some tolerate aspirin some ibuprofen, some nimesulid,
some only paracetamol.

But Aspirin gas proven itself over the years extremely successfully as an
anti-pyretic, analgesic, anticoagulant. That's not common among drugs.

~~~
Udo
I'll try to speak on behalf of the MDs opposed to the general population using
Aspirin at all. I think the main reason is that it's easier to take risks for
yourself where you'd be hesitant to exposing someone else to the same risk.
And they do have a point.

People with bio/medical knowledge are probably able to recognize signs such as
stomach problems and act accordingly, but they can't really expect patients
to. Aspirin messes up coagulation beyond belief. While that is a boon to some
people, issuing a blanket blessing of the substance means _people will die_ in
emergency rooms and on operating tables, people who could have been saved if
they weren't on ASS. For most MDs, weighing that statistical certainty against
a comparatively fuzzy list of preventive benefits which may or may not be
favorable for some patients is not a hard decision to make. Hence the verdict:
"don't use it, even though I myself do use it".

Again, accepting this for yourself can be an informed decision, but it's not
one you want to make on behalf of the general population.

In my case, it's similar. I judge my risk factors in a way that Aspirin is
more likely to prolong my healthy life, but I know there is increased risk of
complications in other areas. I have no doubt that 90% of all GPs when asked
would categorize my taking 250mg per day as abuse.

------
andy_ppp
Yes - there is lots and lots of research that suggests that inflammation is
the cause of a whole host of "western" diseases.

Sugar and fructose cause heart disease (not fat) by irritating the lining of
the heart over and over and over again. Wheat causes inflammation because most
people are allergic to it in some way. Constant insulin response that we have
with all the sugar hidden (and not so hidden) in everything we eat causes
swelling and fat storage. Even the fruits we have now have been bred to be
much much sweeter than 60 years ago.

Lets not even start on how fibre seems to protect against some of the terrible
effects of fructose on the body (rapid conversion to fat - the body can't
tolerate fructose in the blood) and how removing the fibre in the form of
fruit juice or high fructose corn syrup is a disaster for your body.

Probably taking aspirin is unnecessary if you were to avoid the main things
which irritate and cause an immune response in your body. I can bet you that
turmeric tea from the root is going to be as good as aspirin at protecting you
from these diseases but the best plan is to avoid sugar, wheat and high GI
carbohydrates.

~~~
stevebot
I am curious what studies have linked sugar and fructose to heart disease over
fat + cholesterol.

~~~
andy_ppp
1\.
[http://www.ncbi.nlm.nih.gov/pubmed/20888548](http://www.ncbi.nlm.nih.gov/pubmed/20888548)

2\.
[http://www.ncbi.nlm.nih.gov/pubmed/16391215](http://www.ncbi.nlm.nih.gov/pubmed/16391215)

3\.
[http://jama.jamanetwork.com/article.aspx?articleid=202339](http://jama.jamanetwork.com/article.aspx?articleid=202339)

4\.
[http://jama.jamanetwork.com/article.aspx?articleid=377969](http://jama.jamanetwork.com/article.aspx?articleid=377969)

5\.
[http://www.bmj.com/content/346/bmj.e8539](http://www.bmj.com/content/346/bmj.e8539)

6\.
[http://www.ncbi.nlm.nih.gov/pubmed/16340654](http://www.ncbi.nlm.nih.gov/pubmed/16340654)

7
[http://www.ncbi.nlm.nih.gov/pubmed/23021013](http://www.ncbi.nlm.nih.gov/pubmed/23021013)

8\. [http://www.jissn.com/content/1/1/45](http://www.jissn.com/content/1/1/45)

9\.
[http://www.nutritionandmetabolism.com/content/2/1/25](http://www.nutritionandmetabolism.com/content/2/1/25)

10\.
[http://ajcn.nutrition.org/.../01/13/ajcn.2009.27725.abstract](http://ajcn.nutrition.org/.../01/13/ajcn.2009.27725.abstract)

11\.
[http://www.ncbi.nlm.nih.gov/pubmed/19364995](http://www.ncbi.nlm.nih.gov/pubmed/19364995)

12\.
[http://ajcn.nutrition.org/content/67/5/828.short](http://ajcn.nutrition.org/content/67/5/828.short)

13\.
[http://www.ncbi.nlm.nih.gov/pubmed/21735439](http://www.ncbi.nlm.nih.gov/pubmed/21735439)

14\.
[http://www.ncbi.nlm.nih.gov/pubmed/12535503](http://www.ncbi.nlm.nih.gov/pubmed/12535503)

15\.
[http://www.metabolismjournal.com/.../S0026-0495.../abstract](http://www.metabolismjournal.com/.../S0026-0495.../abstract)

16\.
[http://link.springer.com/article/10.1007%2Fs00394-012-0418-1](http://link.springer.com/article/10.1007%2Fs00394-012-0418-1)

17\.
[http://www.nature.com/.../jou.../v64/n6/abs/ejcn201045a.html](http://www.nature.com/.../jou.../v64/n6/abs/ejcn201045a.html)

18\.
[http://ajcn.nutrition.org/content/92/1/34](http://ajcn.nutrition.org/content/92/1/34)

19\.
[http://www.nutritionj.com/content/3/1/9](http://www.nutritionj.com/content/3/1/9)

20\.
[http://www.ncbi.nlm.nih.gov/pubmed/11838888](http://www.ncbi.nlm.nih.gov/pubmed/11838888)

21\.
[http://www.ncbi.nlm.nih.gov/pubmed/20565999](http://www.ncbi.nlm.nih.gov/pubmed/20565999)

~~~
stevebot
Thanks, the conclusions of these articles seems to be that there is not
conclusive evidence that high fat diets are linked to heart disease.

~~~
andy_ppp
Well if we're honest you can cherry pick your research can't you and how you
interpret the results. Can you in return point to me a study that shows
increasing carbohydrate and reducing fat decreases heart disease? I'd suggest
in modern research such findings don't exist.

------
zvrba
Aspirin has anti-inflammatory properties. Could it be that some cancers are a
consequence of a long-term, low-grade inflammation (possibly, a consequence of
infection with some kind of unknown virus)?

Is low-grade inflammation detectable by blood tests?

~~~
riffraff
I know next to nothing about medicine, but at least some cancers (can?) derive
from human papillomavirus[0] infections.

[0]
[http://en.wikipedia.org/wiki/Human_papillomavirus](http://en.wikipedia.org/wiki/Human_papillomavirus)

~~~
pja
That's probably because papillomavirus inactivates two tumour suppressing
proteins in order to allow the host cell to proliferate. Nothing to do with
inflammation per se.

------
epistasis
The full article is freely available [1],and reading the abstract will be more
informative and more accurate than the Guardian article for most HN readers, I
believe. Science journalism has a long ways to go before it can reliably
communicate science results.

[1]
[http://annonc.oxfordjournals.org/content/early/2014/07/30/an...](http://annonc.oxfordjournals.org/content/early/2014/07/30/annonc.mdu225.full)

~~~
danieltillett
It is not just science journalism it is all journalism. In my experience the
most accurate reporting is in science.

Outside of science any reporting that I have had any personal knowledge of has
been so distorted that I wonder if journalists and I inhabit different
universes.

~~~
ekianjo
> In my experience the most accurate reporting is in science.

I agree with your general claim about journalism, but really, "the most
accurate reporting is Science" ? There are so many fallacies embraced by
journalists whenever they review Scientific results (the largest one being the
lack of understanding of the differences between causation and correlation),
that I can't even begin to fathom while that would be more accurate than the
rest.

~~~
danieltillett
I said the most accurate, not accurate :)

In general science reporting is appalling bad, while non-science reporting is
total fiction with a malign bias.

~~~
ekianjo
Got it, I see what you are saying now :)

------
clarky07
Most interesting part, IMO -

"All the cancers in which aspirin has a beneficial effect have some lifestyle
causes – from smoking in lung cancer to alcohol in oesophageal cancer and
obesity in all of them. Taking aspirin, said Cuzick, "should not be seen as a
reason for not improving your lifestyle". The drug, however, would reduce the
cancer risk even in people who have a healthy lifestyle, he said."

Now I left in the last part to be fair, but it seems like perhaps the risks
(bleeding etc) may not outweigh the benefits for people with a healthy
lifestyle.

------
nabla9
Aspirin has potential. It might also help with mood disorders if or when they
are connected to low level chronic inflammation.

(big if, nothing conclusive, just interesting connection)

[http://apt.rcpsych.org/content/14/4/248.full](http://apt.rcpsych.org/content/14/4/248.full)

[http://www.ncbi.nlm.nih.gov/pubmed/15867179](http://www.ncbi.nlm.nih.gov/pubmed/15867179)

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535180/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535180/)

------
fasteo
What I find interesting about aspirin is that no one really knows how it works
(its "mechanism of action"). Its anti-inflamatory effects are a consequence of
something else, not the cause.

In the book "Power, Sex, Suicide"[1], Nick Lane states:

"Curiously, aspirin is also a mild respiratory uncoupler; I do wonder how many
of its more mysterious benefits may relate to this property"

He is talking about the mitochondrial respitarory chain. In this context,
"uncoupled" means that the electron flow does not generate any ATP; instead,
all the energy is dissipated as heat. The interesting thing is that uncoupling
the electron transport chain reduces electron leakage ("free radicals") and
less free radicals has been associatted with ageing and disease.

Will less electron leakage reduce chronic inflamation ? Who knows ...

Once again, the analogy with computer systems is pretty straightforward: If
our back-end system is "inflamed" (read, under heavy load) due to incoming
HTTP requests, uncoupling it with a message queue system will have anti-
inflammatory effects.

[1] [http://www.amazon.com/Power-Sex-Suicide-Mitochondria-
Meaning...](http://www.amazon.com/Power-Sex-Suicide-Mitochondria-
Meaning/dp/0199205647)

[2]
[http://sciencecases.lib.buffalo.edu/cs/files/dinitrophenol.p...](http://sciencecases.lib.buffalo.edu/cs/files/dinitrophenol.ppt)

~~~
robbiep
Hi there,

I think you need to explain yourself a bit better - you have made a statement
that is demonstrably false, at least in the sense that you have used it -

 __ _aspirin is that no one really knows how it works_ __

\- Aspirin works by a very well understood mechanism of binding irreversibly
to the COX enzyme, with a preference for COX1 over COX2. there is no debate
about this.

Thankyou for pointing me down the rabbit-hole regarding uncoupling and the
decrease in free radical production this creates [2], something I was not
previously aware of

[1] Uncoupling of intestinal mitochondrial oxidative phosphorylation and
inhibition of cyclooxygenase are required for the development of NSAID-
enteropathy in the rat doi/10.1046/j.1365-2036.2000.00723.x/

[2] Mitochondria and reactive oxygen species
10.1016/j.freeradbiomed.2009.05.004

~~~
fasteo
Indeed. Wording is important.

I meant that the known mechanism that you have mentioned does not explain all
its reported benefits. Specifically in the anti-inflammatory effect, it seems
like inhibition of prostaglandin synthesis (via COX enzyme binding) is not the
reason[1].

As aspirin has so many potential benefits, it seems to me that it has to have
some effect in some very basic and common site and the mitochondrial
respiratory chain is a good, if not best, candidate.

If you are interested in uncoupling and free radical production, Peter[2] has
a good amount of info about it.

At any rate, aspirin has many knowns unkowns; that´s what I meant in my
original post.

[1]
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213311/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213311/)

[2] [http://high-fat-nutrition.blogspot.com.es/](http://high-fat-
nutrition.blogspot.com.es/)

~~~
robbiep
Thanks for pointing me to that blog, really interesting stuff. Rob

------
ScottWhigham
Am I correct in saying "This isn't a new trial-based study; it's really just
an analysis of available study data based on either (a) other previously
published analyses of this type, or (b) an interpretation on follow-ups of
clinical trials"?

I'm not used to reading science journals so it's possible that I missed
something.

[http://annonc.oxfordjournals.org/content/early/2014/07/30/an...](http://annonc.oxfordjournals.org/content/early/2014/07/30/annonc.mdu225.full)

 _Methods The effect of aspirin for site-specific cancer incidence and
mortality, cardiovascular events was collated from the most recent systematic
reviews. Studies identified through systematic Medline search provided data
regarding harmful effects of aspirin and baseline rates of harms like
gastrointestinal bleeding and peptic ulcer._

~~~
dekhn
[http://en.wikipedia.org/wiki/Meta-
analysis](http://en.wikipedia.org/wiki/Meta-analysis)

------
golemotron
In classic biological fashion i.e., everything is connected and has side-
effects, consistent use of aspirin is also linked to macular degeneration:

[http://www.webmd.com/eye-health/news/20130118/aspirin-
blindi...](http://www.webmd.com/eye-health/news/20130118/aspirin-blinding-eye-
disease)

Cancer or blindness?

------
mastermojo
should I start taking it now, in my 20's, or wait till I'm in my 50's?

~~~
letstryagain
No definitely don't start in your 20s. There's no evidence that the benefits
outweigh the risks at your age.

------
avz
The article did not say what sample size the new research was based on or how
it was conducted, but provided detailed projections over the next 20 years.
Media still giving us all the numbers except the ones that matter.

~~~
gwern
The answer to those questions is not simple; this is reviewing a bunch of
studies and outcomes, so the answer is, it depends. As usual, there is no
substitute for looking at the fulltext, eg
[http://annonc.oxfordjournals.org/content/early/2014/07/30/an...](http://annonc.oxfordjournals.org/content/early/2014/07/30/annonc.mdu225/T1.expansion.html)
(Looks like it omits the metric of most interest to me personally, RCT results
for all-cause mortality, where I believe the cumulative n is ~10-20k.)

------
ASneakyFox
I wouldn't just randomly start taking aspirin every day because of this
article... Im sure the next big aspirin discovery will be "oops all that
asprin is actually bad"

~~~
atmosx
My father does it, many people do in Greece. Not every day regularly but 3-4
times a week. He is fine so far, extremely healthy for his age.

But what you said above could be told/discovered for jus about any drug.

------
matobago
I like more tomato sauce to prevent cancer...

[http://www.ted.com/talks/william_li](http://www.ted.com/talks/william_li)

------
chatmasta
Last time a "cure cancer" article appeared on HN, someone posted a link to
their site, which I found pretty entertaining:

[http://kill-or-cure.herokuapp.com/](http://kill-or-cure.herokuapp.com/)

~~~
danieltillett
I am disappointed that The Daily Mail has not yet found an inanimate object
starting with Z that can cause or prevent cancer. How could they have missed
this on Zinc Oxide [1]!

Edit. I spoke too soon. Thee sleuths at the DM have picked this up [2].

[1] [http://www.huffingtonpost.co.uk/2012/05/09/suncream-skin-
can...](http://www.huffingtonpost.co.uk/2012/05/09/suncream-skin-cancer-
link_n_1502237.html)

[2]
[http://www.dailymail.co.uk/health/article-2141257/Suncream-i...](http://www.dailymail.co.uk/health/article-2141257/Suncream-
ingredient-damage-skin-cells-exposed-UV-rays.html)

------
subverting
Yes! One magic pill will cure everything!

------
gopalv
Next I'll be hearing I should chew willow bark instead of paying for Aspirin
:)

Even if this worked, the amount of misinformation about this has inoculated me
against taking medical decisions myself (other than avoiding the free Twix
littered in the office kitchen).

John Oliver covered this style of journalism, rather sarcastically a while
back.

[https://www.youtube.com/watch?v=WA0wKeokWUU#t=13m09s](https://www.youtube.com/watch?v=WA0wKeokWUU#t=13m09s)

~~~
Alex3917
Meadowsweet or black birch would both be much more sensible than willow bark.
I've heard it claimed that black birch is safer than aspirin, though I've
never seen any evidence of this.

------
manicdee
Time to start selling shares in aspirin producing companies as the naifs rush
in to buy up?

------
visava
So far anybody found out the root cause of cancer. Without knowing the root
cause difficult to find a good bug fix.

~~~
danieltillett
There is no root cause since Cancer is a description of a set of symptoms, not
a single disease. Trying to find the root cause of cancer is like trying to
find the root cause of broken legs.

------
daphneokeefe
Wait, what!? One of my favorite online health info sources just yesterday
headlined "FDA Reverses Its Position on Daily Aspirin"
[http://articles.mercola.com/sites/articles/archive/2014/08/0...](http://articles.mercola.com/sites/articles/archive/2014/08/04/daily-
aspirin-side-effects.aspx) which says only certain ppl may benefit from
regular aspirin. The data do not support the use of aspirin as a preventive
medication ...

~~~
siyer
No one should be using mercola.com as a source for information on anything.
It's one of the most well-known dens of harmful and dangerous pseudoscience on
the internet (see: [http://www.sciencebasedmedicine.org/joe-mercola-quackery-
pay...](http://www.sciencebasedmedicine.org/joe-mercola-quackery-pays/) for
one of many articles the excellent folks over at Science Based Medicine have
written about the site).

