A new study shows that regular aspirin use reduces the risk of myeloma. Researchers from Brigham and Women's Hospital and Harvard University studied 2,395,458 person-years and showed a 39% lower myeloma risk among individuals with a cumulative average of more than 5 adult strength (325 mg) aspirin tablets per week.
Many details were reviewed and assessed as part of this carefully designed study. A "4 year lag period" was built in to exclude patients who might have been developing myeloma in the 4 years prior to the study. Length of aspirin use was considered. Greater than 11 years of use gave the most benefit. Men appeared to derive more benefit than women.
But, as they say, "the devil is in the details." Researchers are always worried that something unforeseen may have skewed the results. Some previous studies have shown no impact from regular aspirin use. However, more recently, there are several reports of reduced risk of solid cancers (such as colon cancer) and lymphomas with regular aspirin use.
There is also a need to understand why the aspirin is working. In research lingo, the results have to be "plausible." There are indeed good reasons why aspirin can provide benefit. The anti-inflammatory and anti-oxidant effects involve key pathways such as NF-kB, COX-2, IL-6, and cyclin D1--all known to be important in myeloma progression. Chronic inflammation produces "free radicals" in the tissues, which among other things can damage DNA. Obviously, reducing or preventing chromosome damage is a very good thing.
This is a carefully designed study, but appropriately the authors advise "caution in the interpretation of our findings." Nonetheless, with something as simple as an aspirin a day, which provides many potential health benefits, the added value is worth considering. A key question is: "Can aspirin use reduce or prevent the activation of MGUS or smoldering myeloma into full blown myeloma?" A tantalizing question indeed! Carefully designed prospective studies are definitely warranted.
It is not clear if a baby aspirin (as used to reduce cardiovascular risks) is sufficient or whether in the case of cancer, a full adult dose (325 mg) provides any additional benefit. Stay tuned for further details. I'm sure new research results will be coming soon.
In the meantime, check with your doctor and unless aspirin use is not possible or not recommended in your situation, "an aspirin a day to keep the doctor away" is perhaps an idea whose time has come while we await definitive long-term results!
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Thanks to the many of you who wrote in about Dr. Durie's blog on the reported effects of daily aspirin on prevention of myeloma. Rather than answer each of you individually, as we normally do, we thought it best to add this addendum to the blog.
The medical article about daily aspirin use and the incidence of myeloma was certainly good food for thought and further research, but really raises more questions than it answers. This is incidental data mined from a large study of male doctors over a long period of time. It was not designed to test any specific hypothesis about the long-term effects of aspirin at a given dose.
Here are some of the things we still don't know:
- We don't know if aspirin merely lowers the risk of the incidence of myeloma, or if it actually has any anti-myeloma effect once a patient has been diagnosed.
- We don't know whether the dose of aspirin is significant: in the study, the men taking the pill were using it for pain relief and were taking at least 325 mg (full-strength) daily. Would 81 mg also be effective? We have no data.
- We don't know how much aspirin a person needs to take over what period of time to have an effect. Is the length of time of aspirin consumption--that is, the total cumulative dose--significant? The benefits of aspirin only became apparent after many years of regular use in the reported study. How much is enough?
Many times Dr. Durie blogs about interesting medical articles relating to myeloma or cancer research because they are good food for thought and for discussion with one's treating physician, and because they provide a new insight or a new theory that will lead to further research.
Our present knowledge of daily aspirin use in the myeloma patient community relates only to its use as prophylaxis (prevention) of "venous thromboembolic events," or VTEs (ie blood clots) in a subset of patients who are receiving therapy with an immunomodulatory agent (IMiD, that is, Thalomid, Revlimid, or Pomalyst) AND dexamethasone. All patients taking a combination IMiD and dex must be assessed for risk of blood clots by the treating physician, and treated according to published guidelines depending upon risk.
Here is a link to the International Myeloma Working Group guidelines on prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma: http://myeloma.org/pdfs/DVTGuidelinesDec2007.pdf
- Aspirin in an NSAID (non-steroidal anti-inflammatory agent). Those who are not supposed to take NSAIDS, usually because of kidney issues, should not consider daily aspirin use.
- Use of aspirin or any other drug specifically to prevent blood clots during therapy with an IMiD alone (for example, during Revmilid maintenance therapy) is NOT recommended by the IMWG.