1. Wolfgang, Kelly

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Recent research published by JAMA Oncology found that regular, low-dose aspirin use lowers the risk of hepatocellular and ovarian cancers. The landmark studies present a turning point in preventative care, providing at-risk patients with hope for precluding the development of these two deadly diseases (2018; doi:10.1001/jamaoncol.2018.4149; 2018; doi:10.1001/jamaoncol.2018.4154). With results showing a staggering 49 percent reduction of risk of developing hepatocellular carcinoma (HCC) and a 23 percent lower risk of ovarian cancer development, these findings offer an exciting new avenue of preventative research.

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Preventative Treatment

Victoria L. Seewaldt, MD, the Ruth Ziegler Professor and Chair of the Department of Population Sciences with a clinical specialty in breast cancer at City of Hope, Duarte, Calif., said the research provides important evidence regarding preventative treatment of the two diseases, something lacking in current care options.


"Prevention has been considered the lesser form of treatment of disease, but as we go forward and find an aging population in the U.S. and all throughout the world, cancer treatments will become more of a burden for society and will inspire people to go forward and develop prevention trials," Seewaldt said. "Current preventative treatment options for ovarian cancer are primarily birth control or tube removal, the latter of which is pretty drastic."


Ovarian cancer is the fifth most common cause of cancer-related death among women in the U.S., making preventative research for the disease vitally important. With growing evidence supporting a role for inflammation in the development of ovarian cancer, anti-inflammatory agents such as aspirin have an influence on development of the disease, the research found.


After analyzing data collected from 93,664 women in the Nurses' Health Study and 11,834 women in the Nurses' Health Study II, researchers reported that risk of ovarian cancer development was reduced among frequent (>=5 days per week) aspirin users, with a significantly lower risk for low-dose aspirin use.


Similarly, regular, long-term aspirin use is associated with a dose-dependent reduction in HCC risk after 5 or more years of use. In a nationwide study, prospective cohorts of 87,507 men and 45,864 women self-reported regular use of standard dose (325 mg) aspirin tablets at least two or more times per week was associated with a 49 percent reduced risk of developing HCC. Seewaldt noted that current preventative recommendations are lacking for the disease, and that the research could result in better outcomes for patients diagnosed with the disease.


"For HCC, there is a high association with hepatitis B. Though we currently have a vaccine to prevent hepatitis B infection, many patients who develop HCC are already infected and the vaccine will have no effect," she said.


Researchers revealed HCC mortality rates are accelerating more rapidly than those for any other cancer, with most patients receiving diagnosis at a late stage and having a median survival of less than 1 year. To combat such high rates, Seewaldt recommends hepatitis B testing for patients aged 50-70 years.


"From the sexual revolution in the 60s and the use of IV drugs, many of the people who are high-risk for developing HCC could already have hepatitis B and not know it. To properly treat these patients, we need early detection and better prevention methods," she noted.


Potential Risks

As with most treatment options, clinicians should make note of the negative associations of regular aspirin use, Seewaldt said. Potential risks include cardiovascular events, hypertension, chronic inflammatory diseases, and bleeding.


"Without a randomized placebo-controlled trial, we don't have enough evidence to recommend regular aspirin use for most people with consideration of the side effects," she explained. "This highlights the importance of funding of prevention trials using repurposed drugs and drugs with low toxicity.


"Aspirin use to prevent ovarian and hepatocellular cancers has potential, but we need to know the mechanism and potential for other low-toxicity drugs being tested prior to moving forward with recommendations," she said.


Garnering Public Support

Seewaldt said that public awareness will be a huge factor in securing funding for additional trials, and she recommends that clinicians educate patients on both ovarian and hepatocellular cancers to seek support in continuing research.


"The larger success of using aspirin as a preventative treatment for ovarian and hepatocellular cancers depends on how much will the public has," she said. "When no one did studies on prostate or breast cancer, the public had the will to demand more research. People went out and wrote to their senators and Congress people and told them we needed more funding."


With that type of public support, Seewaldt believes further testing could be done and clinicians could come forward with specific aspirin dosing recommendations, potentially in the next 5 years. "Never underestimate the power of the public and its ability to really make a difference," she said.


That public support will need to be backed by clinicians who are dedicated to educating their patients about the potentially deadly diseases, Seewaldt urged.


"This research has the potential to truly impact the field of oncology," she said. "An alliance network will inspire people and physicians who have loved ones who have suffered from these diseases to take action.


"You only have to see a couple people die of ovarian cancer before you're inspired to become involved with prevention. Medical oncologists have a tough time and work very hard-they are noble human beings-and it can be hard to care for people with deadly cancers such as these," she stated. "With research as promising as that indicated in these trials, we need to proceed with caution, pick up the mantle in the context of clinical trials, and see through the possibility of moving forward."


Kelly Wolfgang is a contributing writer.