"Compelling" evidence of link between aspirin use, lower hepatoma risk

Reuters Health Information: "Compelling" evidence of link between aspirin use, lower hepatoma risk

"Compelling" evidence of link between aspirin use, lower hepatoma risk

Last Updated: 2018-10-10

By Megan Brooks

NEW YORK (Reuters Health) - Regular, long-term use of aspirin is associated with a reduced risk of developing hepatocellular carcinoma (HCC), according to pooled data from more than 133,000 people.

"Animal studies have shown that aspirin can block primary liver cancers from developing. Although these studies have been promising, data in humans have been limited," said Dr. Andrew Chan from Massachusetts General Hospital, in Boston.

"To date, some human studies suggested potential benefits of aspirin for the prevention of liver cancer," he told Reuters Health by email. "However, most of these studies have been too small or lacked detailed medication data to draw any firm conclusions. Our study provides compelling human evidence that aspirin use, particularly for at least 5 years, is associated with a lower risk of developing liver cancer."

In this population-based study of two nationwide, prospective cohorts of more than 87,000 health professionals and 45,000 nurses, regular use of 325 mg of aspirin at least two or more times weekly was associated with a significant 49% reduction in the risk of developing HCC.

The findings are based on more than 26 years of follow-up, encompassing roughly 4.2 million person-years.

The association was both dose- and duration-dependent, appearing with aspirin use for five years or more, at a dose of 1.5 or more standard 325-mg tablets per week, the authors reported in JAMA Oncology, online October 4. Use of non-aspirin nonsteroidal anti-inflammatory drugs was not significantly associated with HCC risk.

Dr. Chan cautioned that it's "still too early to know whether starting aspirin therapy should be implemented as a strategy for liver-cancer prevention. Further research is needed to corroborate our findings and better define those individuals for whom the benefits of aspirin use clearly outweigh the risks. Most likely, this will include individuals at particularly high risk of liver cancer, such as those who have chronic liver disease, including non-alcoholic fatty liver disease or cirrhosis."

In a linked editorial, Dr. Victoria Seewaldt from City of Hope Comprehensive Cancer Center in Duarte, California, says this is the "strongest evidence to date that aspirin use can reduce the risk of HCC."

While the study has "the power to start to change clinical practice," she says there is still "much to be learned about the mechanism underlying dose and duration of aspirin use." And the potential benefits of aspirin must be weighed against the risk of bleeding, especially in people with chronic liver disease.

A companion paper in JAMA Oncology, based on two cohorts of nurses, showed that regular use of low-dose aspirin (

These two studies are a "critical step in realizing a broader population-wide use of aspirin for cancer chemoprevention. However, to realize the full potential of aspirin in precision chemoprevention, the molecular underpinnings of these important risk reduction effects also need to be defined," concludes Dr. Seewaldt.

The study had no commercial funding. Dr. Chan has previously served as a consultant for Bayer Pharma AG on work unrelated to this study.

SOURCES: https://bit.ly/2IObdj2, https://bit.ly/2IHIigw and https://bit.ly/2RtpAxn

JAMA Oncol 2018.

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