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Can Aspirin Prevent Ovarian Cancer?

You've heard that "an apple a day keeps the doctor away" -- maybe we should change that to "An aspirin a day. . .".  You've also heard doctors recommend that men over age 40 and women at increased risk for heart disease take a baby aspirin a day to reduce heart disease risk.  Now women may have even more reason to consider aspirin therapy. A study reported at the Society of Gynecologic Oncologists annual meeting (3/6/01) suggests that long-term aspirin use may decrease the risk of the most common form of ovarian cancer. 

This prospective study evaluated 748 women for an average of 12 years.  Initial results suggest that aspirin use three or more times per week for at least six months may reduce the risk of epithelial ovarian cancer by 40%. The study was conducted by Dr. Arslan Akhmedkhanov M.D. and his colleagues at New York University School of Medicine, New York and Dr. I. Kato, M. D., Ph.D., at Wayne State University in Detroit. "Evidence suggests that chronic inflammation, similar to the inflammation seen in endometriosis and pelvic inflammatory disease, could be related to epithelial ovarian cancer," said the study's lead author, Arslan Akhmedkhanov, M.D. "One way to evaluate the role of inflammation in ovarian cancer is to examine the effect of common anti-inflammatory medications, such as aspirin on epithelial ovarian cancer risk. Our data, combined with other similar research indicates aspirin may have broader anticarcinogenic properties than previously thought."

The study was conducted using a series of questionnaires.  At the time of enrollment, women answered a questionnaire covering a variety of topics from demographics to reproductive data to medical history.  After the initial questionnaire, follow-up questionnaires were sent every two years to update the information on potential risk factors and to identify newly diagnosed cases of cancer and other medical conditions. 

From 1994 to 1996, detailed data on aspirin use was collected using the following question: Have you taken aspirin three or more times per week for a period of six months or longer?  For women who answered "yes", additional information regarding the dose and duration of aspirin use was requested. A total of 140 women with ovarian cancer were identified after the average follow-up period of 12 years. Of these, 68 women responded to questions on aspirin use in the 1994 --1996 follow-up questionnaire and were diagnosed with common types of epithelial ovarian cancer.

Ten matched controls per case were selected at random among cancer-free cohort members. As a result, 748 women were available for analysis, including 68 women with epithelial ovarian cancer and 680 matched controls.

One weakness of the study is its relatively small sample size and its reliance on women's recall about their aspirin use.  According to Dr. Akhmedkhanov,  "If confirmed by larger prospective studies, these results could have a considerable impact on the treatment and prevention of gynecologic cancers, as well as spark greater interest in researching the broader anticancer effects that aspirin may hold".

This information is still considered a research hypothesis.  Because there are risks associated with regular aspirin use, women should consult with their physicians before starting any long-term aspirin regimens.

According to Dr. Akhmedkhanov, four other case-control studies have addressed the role of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) in ovarian cancer. Three of these studies suggested a protective benefit of regular aspirin and other NSAID use in ovarian cancer. One study found no effect. A recent case-control surveillance study of medication use and cancer, including 780 women with epithelial ovarian cancer from Baltimore, Boston, New York, and Philadelphia, found a 50 percent reduction in epithelial ovarian cancer risk when aspirin was used four or more times per week for at least five years. These results are comparable to the results of this most recent study.

Why is this news particularly exciting?  First of all, it's welcome news because ovarian cancer has an insidious onset and it's often difficult to diagnose.  In addition, there are no reliable screening tests for ovarian cancer. Ovarian cancer is the most serious cancer affecting women's reproductive organs.  It ranks fifth as a cause of cancer deaths among women, and causes more deaths than any other cancer of the female reproductive system.  The Society of Gynecologic Oncologists estimates that there will be 23,400 new cases of ovarian cancer diagnosed and approximately 14,000 deaths from ovarian cancer in the United States during 2001 alone.

Ovarian cancer usually arises on the surface of the ovary in the epithelial layer --this was the type of ovarian cancer diagnosed in this study.  We know several risk factors for ovarian cancer -- increasing age, family history of ovarian cancer, infertility, not having given birth, and having a genetic mutation for breast cancer.  Interestingly, the only known factors that decrease the risk of ovarian cancer are each additional pregnancy a woman has and taking birth control pills for at least 5 years.  Taking birth control pills for at least 5 years may reduce a woman's risk of ovarian cancer by 40% to 60%, slightly more than the risk reduction suggested for aspirin in this study.

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Created: 3/8/2001  -  Donnica Moore, M.D.


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