What is the clinical evidence from this study?

Study design: Cohort. Population: Breast cancer (n=4627). Intervention: Aspirin vs. No aspirin use postdiagnosis. Primary outcome: All-cause mortality (HR 0.53, 95% CI 0.45-0.63, p=<0.001).

June 19, 2014British Journal of Cancer107 citationsOpen Access

Aspirin use and survival after the diagnosis of breast cancer: a population-based cohort study

Q: What are the key findings of this study?

Aspirin use following a diagnosis of breast cancer was associated with a significantly lower risk of all-cause mortality (HR 0.53) compared to non-use.

DFD M Fraser FSFrank Sullivan ATAlastair M. Thompson

Key Result

Aspirin use following a diagnosis of breast cancer was associated with a significantly lower risk of all-cause mortality (HR 0.53) compared to non-use.

Study Design

Type

Cohort (n=4,627)

PICO

Population

4,627 women with primary invasive breast cancer, free of prior cancers, followed for a median of 5.7 years.

Exposure / Comparator

Aspirin vs No aspirin use postdiagnosis

Primary Outcome

All-cause mortality — HR 0.53 (0.45-0.63), p=<0.001

Main Result

Hazard Ratio: 0.53 (95% CI 0.45–0.63)

p-value: p=<0.001

Limitations

Lack of over-the-counter medication information
No recurrence information available
Indication for aspirin prescription and actual use not recorded
No patient data on smoking status or BMI
No information on toxicity and side effects from aspirin use
Observational study design with potential for unmeasured residual confounders

Abstract

BACKGROUND: Aspirin use has been associated with a reduced cancer incidence and fewer deaths from cancer. This study examined whether women with breast cancer prescribed aspirin postdiagnosis had improved survival. METHODS: An observational, population cohort study was undertaken using data linkage of cancer registry, dispensed prescriptions and death records in Tayside, Scotland. All community prescriptions for aspirin in women with breast cancer were extracted and use postdiagnosis for each individual examined using Cox's proportional hazard models. The main outcome measures were all-cause mortality and breast cancer-specific mortality. RESULTS: Four thousand six hundred and twenty-seven patients diagnosed with breast cancer between 1 January 1998 and 31 December 2008 were followed up until 28 February 2010. Median age at diagnosis was 62 (IQR 52-74). One thousand eight hundred and two (39%) deaths were recorded, with 815 (18%) attributed to breast cancer. One thousand and thirty-five (22%) patients were prescribed aspirin postdiagnosis. Such aspirin use was associated with lower risk of all-cause mortality (HR=0.53, 95% CI=0.45-0.63, P<0.001) and breast cancer-specific mortality (HR=0.42, 95% CI=0.31-0.55, P<0.001) after adjusting for age, socioeconomic status, TNM stage, tumour grade, oestrogen receptor status, surgery, radiotherapy, chemotherapy, adjuvant endocrine therapy and aspirin use prediagnosis. CONCLUSIONS: Aspirin use postdiagnosis of breast cancer may reduce both all-cause and breast cancer-specific mortality. Further investigation seeking a causal relationship and which subgroups of patients benefit most await ongoing randomised controlled trials.

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