The People's Perspective on Medicine

Will Aspirin Keep Barrett’s from Turning into Cancer?

Research suggests that aspirin blocks a key inflammatory pathway cells utilize when they are becoming cancerous and could prevent esophageal cancer.

Barrett’s esophagus is a condition in which the tissue lining the bottom of the food tube changes to resemble tissue lining the intestine. It is considered a pre-cancerous condition and is often associated with acid reflux.

Sometimes when people with Barrett’s esophagus hear that it increases the risk of esophageal cancer, they become understandably frightened. It turns out, however, that the risk of developing esophageal cancer following a diagnosis of Barrett’s is quite low, about 1.2 cases per 1,000 person-years (Hvid-Jensen et al, New England Journal of Medicine, Oct. 13, 2011).

Keeping Barrett’s Esophagus from Turning into Esophageal Cancer:

Still, cancer is scary, and esophageal cancer is difficult to treat. Research suggests, however, that a very old drug might prevent Barrett’s esophagus from turning into esophageal cancer (Huo et al, Gut, online, April 25, 2017).

Is Aspirin a Miracle Drug?

That old drug is aspirin. Although aspirin can irritate the digestive tract, it blocks an inflammatory pathway thought to play a role in cancer development. Fortunately, this research complements epidemiological studies suggesting that aspirin use reduces the risk of esophageal cancer.

Aspirin and Cancer:

Esophageal cancer is not the only malignancy that might be thwarted by regular aspirin use. Research has shown that people who take aspirin regularly are less likely to develop several gastrointestinal cancers (Jacobs et al, Journal of the National Cancer Institute, Aug. 21, 2012). Regular aspirin users are less susceptible to many different kinds of cancer. These may include lung, stomach, prostate and breast cancer and even melanoma.

Breast Cancer:

Low-dose aspirin may help put the brakes on breast cancer. Aspirin at low levels inhibits two different lines of breast cancer cells grown in culture. One is a hard-to-treat triple-negative line. Aspirin also improves the response to tamoxifen in hormone-receptor-positive breast cancer cells. A clinical trial of breast cancer patients with HER2 negative breast cancer will examine whether aspirin after treatment with radiation, surgery or chemotherapy can reduce the risk of recurrence.

Colon Cancer:

A Dutch study of nearly 1,000 colon cancer patients who went through surgery between 2002 and 2008 found that those who had been given a prescription for aspirin after being diagnosed with colon cancer were more likely to survive (JAMA Internal Medicine, March 31, 2014). The aspirin was primarily low-dose aspirin, frequently prescribed to protect the heart from blood clots.

Approximately 38 percent of the aspirin users died during the follow-up period, compared to 49 percent of those who did not take aspirin. The strongest benefit from aspirin was in patients whose tumors showed expression of HLA class 1 antigen. When the tumors had lost that expression, aspirin was not effective in promoting survival.

In an editorial comment on the report, a physician noted that often one of the first questions patients or their family members ask after learning of a cancer diagnosis is “What can we do?” Now, suggesting low dose aspirin seems like a reasonable recommendation.

What Is Aspirin Doing?

A recent review suggests that aspirin helps because it inhibits platelets, thought to help cancer cells spread (Mitrugno et al, Platelets, online Dec. 21, 2017). Other researchers have suggested that a combination of aspirin and a high-fiber diet rich in vegetables might be protective (Pan et al, International Journal of Molecular Science, Jan. 6, 2018). Aspirin is not universally helpful, however. Danish investigators found no benefit from low-dose aspirin for women with ovarian cancer (Verdoodt et al, British Journal of Cancer, online Jan. 9, 2018).

Should You Be Taking Aspirin?

A recent review found that aspirin does appear to reduce the risk of cancer and the chance of dying from cancer (Ringerike, Couto & Klemp, NIPH Systematic Reviews, No. 18-2013). It can be difficult to determine whether the benefits of aspirin in preventing cancer or recurrence are worth the risks of gastrointestinal irritation, ulcers and even hemorrhage. The decision is best made in consultation with your primary health care provider, as we advised this reader.

Q. I am utterly confused about aspirin. I read recently that the FDA discouraged the use of aspirin to prevent heart attacks. Now I read that regular aspirin use lowers the risk of cancer. So, should people take aspirin or not?

Aspirin Is Not Appropriate for Primary Prevention of Heart Attacks:

A. In 2014, the FDA determined that aspirin should not be used to prevent a first heart attack. According to the agency, the benefit is too low and the risk of internal bleeding is too high.

More recently an analysis of 200 aspirin studies found that a daily dose of this old drug can significantly lower the risk of several common cancers (Cuzick et al, Annals of Oncology, Jan. 2015). The researchers concluded that the benefits outweigh the harms when it comes to cancer prevention, especially in high-risk individuals.

If Your Risk Is High, Aspirin Might Make Sense:

Please discuss your individual risks with your primary care provider to determine if aspirin would be helpful either to prevent a second (or third) heart attack or to lower an elevated risk of cancer. Those who would like more information on the pros and cons of aspirin in general may wish to consult our free Guide to Key Aspirin Information.

Revised 1/11/18

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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I have a long history of stomach upset, acid reflux, etc and have used alka-seltzer to help. Will the benefits of acid neutralizing offset the issues of asprin in the digestive system? Are there issues I should know about associated with frequent use of alka-seltzer?

The sodium bicarbonate that makes Alka-Seltzer probably cannot reverse the irritation caused by aspirin.

As a TNBC survivor of 13 years and a former aspirin user, I am going back to my preferred treatment for an occasional headache. Thanks, PPh.

I have been taking low dose aspirin for several months for sleep and for colon lesions in the past
Now I have read of a study that aspirin may hasten the onset of wet macular degeneration. Any news on that issue ?

I think aspirin is a wonder drug. I used it for 50+ years for arthritis pain. I think if it were put out on the market today it would probably require a prescription. It is truly a wonder drug for me.

I’m allergic to aspirin and aspirin products, such as Advil, excedrin, etc. So, it’s difficult reading about it’s good qualities when I can’t take advantage. Maybe I should try a baby aspirin or half of one to see if It will stay down. Does any one know of folks like me who tolerate a baby aspirin or half of one?

If you are actually allergic to aspirin, you should not tempt fate by taking even a small dose. Stay safe!

Is there a way to take a daily baby aspirin and mitigate the effects it may have on irritating the digestive system?
I also read recently that enteric coated aspirin do more harm to the stomach than chewable.

Taking low-dose aspirin: take it with at least 200 mg vitamin C, and it protects against some of the aspirin irritation.

Enteric coated aspirin does not dissolve in the stomach, so it does less damage to the stomach. However, it can damage the small intestine.

I have taken aspirin once or twice daily for many years. After a triple bypass in 2015, I was prescribed two 81mg aspirin daily. I had always used coated aspirin; however, I read that the coated ones don’t dissolve in the correct area of the digestive system to be effective. I now chew one after breakfast and another after dinner. The instrictions on the aspirin bottle require a full glass of water be taken with each. I wash each down with 8-12 oz. of water. Do you think these are the correct steps?

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