Guidelines for Cancer

March 2018

UK Guidelines

NICE do not currently have recommendations for aspirin for cancer prevention or have cancer prevention guidelines other than; CRC prevention: colonoscopic surveillance in adults with ulcerative colitis , Crohn’s disease or adenomas and skin cancer prevention guidelines.

SIGN 126 Diagnosis and management of colorectal cancer December 2011 (Last revision August 2016 - listed as some recommendations may be out of date) states;

3.6 CHEMOPREVENTION USING NSAIDS
“The weight of evidence (covering more than 18,000 cases) for a protective effect of aspirin use against colorectal cancer, and the consistency of the effect in studies differing in design, location, population and motivating hypothesis means that chance alone cannot explain the inverse relation between aspirin use and colorectal cancer. Detection bias, bias due to indications for use of aspirin, other confounding factors, problems in the measurement of aspirin use and publications bias individually would not provide a reasonable explanation for the findings, although a possible cumulative effect of these issues cannot be completely excluded. The evidence relating to other types of non-steroidal anti-inflammatory drug (NSAID) is much less substantial.

Detailed consideration of the total benefits in the prevention of colorectal cancer and other diseases in relation to toxicity will be required before use of aspirin in the prevention of colorectal cancer can be recommended.” 


USA GUIDELINES

PRIMARY PREVENTION OF COLORECTAL CANCER/ALL GI CANCERS

The USPSTF recommends low-dose aspirin for the prevention of colorectal cancer in certain groups (see primary prevention of CVD above).

The National Cancer Institute has information on aspirin to reduce cancer risk that has been updated Feb 2017 (https://www.cancer.gov/about-cancer/causes-prevention/research/aspirin-cancer-risk). This is an update on a previous article April 2015 reviewing the evidence for aspirin and cancer prevention called “No easy answers about whether aspirin lowers cancer risk”. The 2017 information ‘Aspirin to reduce cancer risk’ supports the USPSTF 2016 recommendations.  The 2017 article describes consistent data for the use of aspirin to reduce the risk of colorectal cancer and supports the USPSTF guidance on using aspirin in population groups where the potential benefit is highest and risk lowest.  They describe how the ‘jury is still out’ on the role of aspirin in reducing the risk of other cancers. The article discusses how aspirins protective effects may depend as much on biological factors as it does on cancer type and reviews some of the current research on aspirins risks versus benefits.

The American Cancer Society has a September 2015 article discussing the research into aspirin and cancer prevention and the USPSTF (proposed) recommendations (Mendes 2015 Aspirin and Cancer Prevention: What the Research Really Shows). The article concludes;

“Neither the American Cancer Society, nor any other health organization, recommends taking aspirin solely to help prevent cancer. People who are wondering if they should take aspirin should talk to their health care provider, who knows their individual medical history and is aware of other medications they may be using, and can take this into account when weighing the overall risks and benefits of aspirin use for them.”


EUROPEAN GUIDELINES

PRIMARY PREVENTION OF COLORECTAL CANCER/ALL GI CANCERS

European Cancer Prevention (ECP) and its journal the European Journal of Cancer Prevention (EJCP) have an interest in the role of aspirin and cancer prevention. In their journal they state;

“chemoprevention has a relevant role for reducing risk of selected cancer sites, particularly of the colorectum and of hormone-related sites. This field (again, from cells to rodents, to clinical trials, to populations) has substantially developed over the last two decades, and continuum attention has been given to it by the EJCP)  www.ecpo.org/?page_id=12

EuropaColon is:

“committed to preventing deaths from colorectal cancer and improving the quality of life and support for those affected by the disease.”

EuropaColon has a number of news articles about aspirin and cancer prevention.

ROLE O​​​​F ASPIRIN IN DELAYING THE SPREAD OF CANCER

EuropaColon (see above) has a news article regarding aspirin and cancer recurrence and survival.


CHINESE GUIDELINES

To be developed