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December 10, 2010

Low dose aspirin could help protect against death from cancer

Low dose aspirin could help protect against death from cancer

An article published online on December 7, 2010 in The Lancet reveals a protective effect of low dose aspirin against the risk of dying from a number of cancers. "These findings provide the first proof in man that aspirin reduces deaths due to several common cancers," the authors announce.

Peter Rothwell of Oxford University and his colleagues pooled data from 8 randomized trials comparing the use of aspirin to no aspirin or another blood thinning agent to prevent vascular disease. The trials' treatment periods averaged at least 4 years, and 20 year post-trial follow-up data was available for participants in three trials.

Six hundred seventy-four deaths from cancer occurred during the trials among a total of 25,570 subjects. Those who received aspirin had a 21 percent reduced risk of dying from cancer over the treatment periods compared to those who did not receive the drug. Further analysis found a significant benefit after 5 years of follow-up, with aspirin use associated with a 34 percent lower risk of dying from all cancers and a 54 percent lower risk of dying from gastrointestinal cancer. For the 12,659 participants in the trials that followed patients for 20 years, the risk of dying from all solid cancers remained lower by 20 percent in aspirin users, and by 35 percent for GI cancers, with treatment periods of at least seven and one half years associated with further benefit. Doses of aspirin higher than 75 milligrams were not associated with increased protection. The effects were not dependent upon gender or smoking status, and were greatest for adenocarcinoma.

"Our results have implications for understanding of carcinogenesis, particularly for adenocarcinoma, and they demonstrate the potential for drug intervention in the prevention of cancer," the authors conclude. "Although the effect of aspirin may be mediated in part by inhibition of COX-2, more research is required, other pro-apoptotic effects early in the development of tumours perhaps also being important."

"These are very exciting and potentially important findings," stated Professor Tom Meade of the London School of Hygiene & Tropical Medicine, who conducted one of the trials included in the analysis. "They are likely to alter clinical and public health advice about low dose aspirin because the balance between benefit and bleeding has probably been altered towards using it."

"These results do not mean that all adults should immediately start taking aspirin, but they do demonstrate major new benefits that have not previously been factored into guideline recommendations," Dr Rothwell emphasized. "Perhaps the most important finding for the longer-term is the proof of principle that cancers can be prevented by simple compounds like aspirin and that 'chemoprevention' is therefore a realistic goal for future research with other compounds."

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Cancer adjuvant therapy

The following compendium drawn (in part) from Beyond Aspirin (Newmark et al. 2000) underscores herbs that inhibit COX-2, an enzyme intricately involved in the cancer process. Natural compounds usually have many mechanisms of action; thus, the protective mechanisms common to the herb often extend beyond enzyme inhibition and are described herein. Because of the synergism of herbs, combinations are often of greater value than a single herb.

Berberine, strong and bitter in taste and found in various herbs, delivers anti-inflammatory properties via COX-2 inhibition (Fukuda et al. 1999). Kaempferol, a constituent of berberine, is a strikingly active inhibitor of COX-2 activity (Chen et al. 1999; Newmark et al. 2000). Berberine is unique, having the ability to inhibit COX-2 activity without involving the beneficial COX-1 enzyme.

The anti-inflammatory traits of feverfew have an ability to inhibit the COX-2 enzyme (Hwang et al. 1996). According to Newmark et al. (2000), feverfew contains a lactone, or chemical compound called parthenolide. Parthenolide, in turn, contains a variant of methylene-gamma-lactone (MGL) that interacts with macrophages. The white blood cell-lactone interaction suppresses a critical protein process, a repression that ultimately inhibits the COX-2 enzyme. In addition, feverfew contains apigenin (a flavonoid) and melatonin, both COX-2 inhibitors (Murch et al. 1997).

From the scores of biologically active components contained in ginger, some are specific for inhibiting COX-2 and others for inhibiting 5-lipoxygenase, enzymes responsible for the formation of pro-inflammatory agents (prostaglandin E2 and leukotriene B4) from AA. Ginger safely modulates COX-2 activity but also brings balance to COX-1 (an enzyme responsible for gastric mucosal integrity) in a manner vastly superior to synthetic NSAIDs (Newmark et al. 2000; Reiter et al. 2001).

Salicylic acid, the main anti-inflammatory component of aspirin, is a naturally occurring compound found in green tea, having COX-2 inhibiting qualities. The polyphenols and flavonoids contained in green tea are also COX-2 inhibitors (Noreen et al. 1998).

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