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Long-term aspirin use for primary cancer prevention: An updated systematic review and subgroup meta-analysis of 29 randomized clinical trials
Background and objective: Long-term aspirin use for the primary prevention of cancer remains controversial, and variations in the effect of aspirin use on cancer outcomes by aspirin dose, follow-up duration, or study population have never been systematically evaluated. The objective of this study wa...
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Published in: | Journal of Cancer 2020-01, Vol.11 (21), p.6460-6473 |
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creator | Wu, Qibiao Yao, Xiaojun Chen, Hongwei Liu, Zhengtang Li, Ting Fan, Xingxing Zhang, Guilin Yu, Lili Chen, Min Xu, Cong Zhang, Ruonan Chen, Bi Sui, Xinbing Leung, Elaine Lai-Han |
description | Background and objective: Long-term aspirin use for the primary prevention of cancer remains controversial, and variations in the effect of aspirin use on cancer outcomes by aspirin dose, follow-up duration, or study population have never been systematically evaluated. The objective of this study was to evaluate the effect of aspirin on primary cancer prevention and to determine whether the effect differed according to aspirin dose, follow-up duration, or study population. Materials and methods: Seven electronic databases were searched from inception to September 30, 2019. Randomized clinical trials (RCTs) that compared aspirin use versus no aspirin use in participants without pre-existing cancer and reported cancer outcomes were selected. Data were screened and extracted by different investigators. Analyses were performed using Review Manager 5.3 and Comprehensive Meta-Analysis 2.0. Total cancer incidence was defined as the primary clinical endpoint. Total cancer mortality, all-cause mortality, major bleeding, and total bleeding events were the secondary outcomes. Subgroup analyses were conducted based on aspirin dose, follow-up duration, and study populations. Results: Twenty-nine RCTs that randomized 200,679 participants were included. Compared with no aspirin, aspirin use was not associated with significant reductions in total cancer incidence (RR = 1.01, 95% CI: 0.97 to 1.04, P = 0.72), total cancer mortality (RR = 1.00, 95% CI: 0.93 to 1.07, P = 0.90), or all-cause mortality (RR = 0.98, 95% CI: 0.94 to 1.02, P =0.31); however, aspirin use was associated with a 44% increase in the risk of major bleeding (RR = 1.44, 95% CI: 1.32 to 1.57, P < 0.00001) and a 52% increase in the risk of total bleeding events (RR = 1.52, 95% CI: 1.33 to 1.74, P < 0.00001). Subgroup analyses demonstrated consistent results. Conclusions: Long-term aspirin use in individuals without pre-existing cancer was not associated with a significant reduction in total cancer incidence, cancer mortality, or all-cause mortality; however, aspirin use was associated with a significant increase in the risk of bleeding. Therefore, aspirin is not an appropriate choice for the primary cancer prevention. |
doi_str_mv | 10.7150/jca.49001 |
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fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7532493</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2449958033</sourcerecordid><originalsourceid>FETCH-LOGICAL-c380t-a1a5abfedc3f40eba0fe728961f1f1829223b234752cd373e917f45edcb8c0293</originalsourceid><addsrcrecordid>eNpdkc-OFCEQxonRuJt1D74BiRc99AoUPd14MNls_JdM4kXPpJopRibd0EL3bsZ38J1l3YlR4VBQ_OoLVR9jz6W46mQrXh8cXmkjhHzEzmUPXWM2G_34r_MZuyzlIOoCozoNT9kZgABoQZyzn9sU981CeeJY5pBD5Gsh7lPmcw4T5iN3GB3dX-mW4hJSfMOvKzXvcKEdL8ey0IRLcLwCge44xppdh31O68wnWrDBiOOxhMKT58rwXIk0hR-12o0hBocjX3LAsTxjT3wNdHmKF-zr-3dfbj42288fPt1cbxsHvVgalNji4GnnwGtBAwpPnerNRvq6e2WUgkGB7lrldtABGdl53VZ-6J1QBi7Y2wfdeR2mmq59ZRztqWObMNh_X2L4Zvfp1nYtKG2gCrw8CeT0faWy2CkUR-OIkdJarNLamLavU67oi__QQ1pznUilWtOD6oXcVOrVA-VyKiWT__MZKey9z7b6bH_7DL8AdHecgw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2598328016</pqid></control><display><type>article</type><title>Long-term aspirin use for primary cancer prevention: An updated systematic review and subgroup meta-analysis of 29 randomized clinical trials</title><source>Publicly Available Content Database</source><source>PubMed Central</source><creator>Wu, Qibiao ; Yao, Xiaojun ; Chen, Hongwei ; Liu, Zhengtang ; Li, Ting ; Fan, Xingxing ; Zhang, Guilin ; Yu, Lili ; Chen, Min ; Xu, Cong ; Zhang, Ruonan ; Chen, Bi ; Sui, Xinbing ; Leung, Elaine Lai-Han</creator><creatorcontrib>Wu, Qibiao ; Yao, Xiaojun ; Chen, Hongwei ; Liu, Zhengtang ; Li, Ting ; Fan, Xingxing ; Zhang, Guilin ; Yu, Lili ; Chen, Min ; Xu, Cong ; Zhang, Ruonan ; Chen, Bi ; Sui, Xinbing ; Leung, Elaine Lai-Han</creatorcontrib><description>Background and objective: Long-term aspirin use for the primary prevention of cancer remains controversial, and variations in the effect of aspirin use on cancer outcomes by aspirin dose, follow-up duration, or study population have never been systematically evaluated. The objective of this study was to evaluate the effect of aspirin on primary cancer prevention and to determine whether the effect differed according to aspirin dose, follow-up duration, or study population. Materials and methods: Seven electronic databases were searched from inception to September 30, 2019. Randomized clinical trials (RCTs) that compared aspirin use versus no aspirin use in participants without pre-existing cancer and reported cancer outcomes were selected. Data were screened and extracted by different investigators. Analyses were performed using Review Manager 5.3 and Comprehensive Meta-Analysis 2.0. Total cancer incidence was defined as the primary clinical endpoint. Total cancer mortality, all-cause mortality, major bleeding, and total bleeding events were the secondary outcomes. Subgroup analyses were conducted based on aspirin dose, follow-up duration, and study populations. Results: Twenty-nine RCTs that randomized 200,679 participants were included. Compared with no aspirin, aspirin use was not associated with significant reductions in total cancer incidence (RR = 1.01, 95% CI: 0.97 to 1.04, P = 0.72), total cancer mortality (RR = 1.00, 95% CI: 0.93 to 1.07, P = 0.90), or all-cause mortality (RR = 0.98, 95% CI: 0.94 to 1.02, P =0.31); however, aspirin use was associated with a 44% increase in the risk of major bleeding (RR = 1.44, 95% CI: 1.32 to 1.57, P < 0.00001) and a 52% increase in the risk of total bleeding events (RR = 1.52, 95% CI: 1.33 to 1.74, P < 0.00001). Subgroup analyses demonstrated consistent results. Conclusions: Long-term aspirin use in individuals without pre-existing cancer was not associated with a significant reduction in total cancer incidence, cancer mortality, or all-cause mortality; however, aspirin use was associated with a significant increase in the risk of bleeding. Therefore, aspirin is not an appropriate choice for the primary cancer prevention.</description><identifier>ISSN: 1837-9664</identifier><identifier>EISSN: 1837-9664</identifier><identifier>DOI: 10.7150/jca.49001</identifier><identifier>PMID: 33033530</identifier><language>eng</language><publisher>Wyoming: Ivyspring International Publisher Pty Ltd</publisher><subject>Angina pectoris ; Aspirin ; Cancer ; Diabetes ; Diabetic retinopathy ; Disease prevention ; Heart attacks ; Hypertension ; Males ; Medical screening ; Meta-analysis ; Mortality ; Population ; Research Paper ; Stroke ; Systematic review ; Tumors</subject><ispartof>Journal of Cancer, 2020-01, Vol.11 (21), p.6460-6473</ispartof><rights>2020. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The author(s) 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c380t-a1a5abfedc3f40eba0fe728961f1f1829223b234752cd373e917f45edcb8c0293</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2598328016/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2598328016?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,313,314,723,776,780,788,881,25730,27898,27900,27901,36988,36989,44565,53765,53767,75095</link.rule.ids></links><search><creatorcontrib>Wu, Qibiao</creatorcontrib><creatorcontrib>Yao, Xiaojun</creatorcontrib><creatorcontrib>Chen, Hongwei</creatorcontrib><creatorcontrib>Liu, Zhengtang</creatorcontrib><creatorcontrib>Li, Ting</creatorcontrib><creatorcontrib>Fan, Xingxing</creatorcontrib><creatorcontrib>Zhang, Guilin</creatorcontrib><creatorcontrib>Yu, Lili</creatorcontrib><creatorcontrib>Chen, Min</creatorcontrib><creatorcontrib>Xu, Cong</creatorcontrib><creatorcontrib>Zhang, Ruonan</creatorcontrib><creatorcontrib>Chen, Bi</creatorcontrib><creatorcontrib>Sui, Xinbing</creatorcontrib><creatorcontrib>Leung, Elaine Lai-Han</creatorcontrib><title>Long-term aspirin use for primary cancer prevention: An updated systematic review and subgroup meta-analysis of 29 randomized clinical trials</title><title>Journal of Cancer</title><description>Background and objective: Long-term aspirin use for the primary prevention of cancer remains controversial, and variations in the effect of aspirin use on cancer outcomes by aspirin dose, follow-up duration, or study population have never been systematically evaluated. The objective of this study was to evaluate the effect of aspirin on primary cancer prevention and to determine whether the effect differed according to aspirin dose, follow-up duration, or study population. Materials and methods: Seven electronic databases were searched from inception to September 30, 2019. Randomized clinical trials (RCTs) that compared aspirin use versus no aspirin use in participants without pre-existing cancer and reported cancer outcomes were selected. Data were screened and extracted by different investigators. Analyses were performed using Review Manager 5.3 and Comprehensive Meta-Analysis 2.0. Total cancer incidence was defined as the primary clinical endpoint. Total cancer mortality, all-cause mortality, major bleeding, and total bleeding events were the secondary outcomes. Subgroup analyses were conducted based on aspirin dose, follow-up duration, and study populations. Results: Twenty-nine RCTs that randomized 200,679 participants were included. Compared with no aspirin, aspirin use was not associated with significant reductions in total cancer incidence (RR = 1.01, 95% CI: 0.97 to 1.04, P = 0.72), total cancer mortality (RR = 1.00, 95% CI: 0.93 to 1.07, P = 0.90), or all-cause mortality (RR = 0.98, 95% CI: 0.94 to 1.02, P =0.31); however, aspirin use was associated with a 44% increase in the risk of major bleeding (RR = 1.44, 95% CI: 1.32 to 1.57, P < 0.00001) and a 52% increase in the risk of total bleeding events (RR = 1.52, 95% CI: 1.33 to 1.74, P < 0.00001). Subgroup analyses demonstrated consistent results. Conclusions: Long-term aspirin use in individuals without pre-existing cancer was not associated with a significant reduction in total cancer incidence, cancer mortality, or all-cause mortality; however, aspirin use was associated with a significant increase in the risk of bleeding. Therefore, aspirin is not an appropriate choice for the primary cancer prevention.</description><subject>Angina pectoris</subject><subject>Aspirin</subject><subject>Cancer</subject><subject>Diabetes</subject><subject>Diabetic retinopathy</subject><subject>Disease prevention</subject><subject>Heart attacks</subject><subject>Hypertension</subject><subject>Males</subject><subject>Medical screening</subject><subject>Meta-analysis</subject><subject>Mortality</subject><subject>Population</subject><subject>Research Paper</subject><subject>Stroke</subject><subject>Systematic review</subject><subject>Tumors</subject><issn>1837-9664</issn><issn>1837-9664</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNpdkc-OFCEQxonRuJt1D74BiRc99AoUPd14MNls_JdM4kXPpJopRibd0EL3bsZ38J1l3YlR4VBQ_OoLVR9jz6W46mQrXh8cXmkjhHzEzmUPXWM2G_34r_MZuyzlIOoCozoNT9kZgABoQZyzn9sU981CeeJY5pBD5Gsh7lPmcw4T5iN3GB3dX-mW4hJSfMOvKzXvcKEdL8ey0IRLcLwCge44xppdh31O68wnWrDBiOOxhMKT58rwXIk0hR-12o0hBocjX3LAsTxjT3wNdHmKF-zr-3dfbj42288fPt1cbxsHvVgalNji4GnnwGtBAwpPnerNRvq6e2WUgkGB7lrldtABGdl53VZ-6J1QBi7Y2wfdeR2mmq59ZRztqWObMNh_X2L4Zvfp1nYtKG2gCrw8CeT0faWy2CkUR-OIkdJarNLamLavU67oi__QQ1pznUilWtOD6oXcVOrVA-VyKiWT__MZKey9z7b6bH_7DL8AdHecgw</recordid><startdate>20200101</startdate><enddate>20200101</enddate><creator>Wu, Qibiao</creator><creator>Yao, Xiaojun</creator><creator>Chen, Hongwei</creator><creator>Liu, Zhengtang</creator><creator>Li, Ting</creator><creator>Fan, Xingxing</creator><creator>Zhang, Guilin</creator><creator>Yu, Lili</creator><creator>Chen, Min</creator><creator>Xu, Cong</creator><creator>Zhang, Ruonan</creator><creator>Chen, Bi</creator><creator>Sui, Xinbing</creator><creator>Leung, Elaine Lai-Han</creator><general>Ivyspring International Publisher Pty Ltd</general><general>Ivyspring International Publisher</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PIMPY</scope><scope>PKEHL</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200101</creationdate><title>Long-term aspirin use for primary cancer prevention: An updated systematic review and subgroup meta-analysis of 29 randomized clinical trials</title><author>Wu, Qibiao ; Yao, Xiaojun ; Chen, Hongwei ; Liu, Zhengtang ; Li, Ting ; Fan, Xingxing ; Zhang, Guilin ; Yu, Lili ; Chen, Min ; Xu, Cong ; Zhang, Ruonan ; Chen, Bi ; Sui, Xinbing ; Leung, Elaine Lai-Han</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c380t-a1a5abfedc3f40eba0fe728961f1f1829223b234752cd373e917f45edcb8c0293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Angina pectoris</topic><topic>Aspirin</topic><topic>Cancer</topic><topic>Diabetes</topic><topic>Diabetic retinopathy</topic><topic>Disease prevention</topic><topic>Heart attacks</topic><topic>Hypertension</topic><topic>Males</topic><topic>Medical screening</topic><topic>Meta-analysis</topic><topic>Mortality</topic><topic>Population</topic><topic>Research Paper</topic><topic>Stroke</topic><topic>Systematic review</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wu, Qibiao</creatorcontrib><creatorcontrib>Yao, Xiaojun</creatorcontrib><creatorcontrib>Chen, Hongwei</creatorcontrib><creatorcontrib>Liu, Zhengtang</creatorcontrib><creatorcontrib>Li, Ting</creatorcontrib><creatorcontrib>Fan, Xingxing</creatorcontrib><creatorcontrib>Zhang, Guilin</creatorcontrib><creatorcontrib>Yu, Lili</creatorcontrib><creatorcontrib>Chen, Min</creatorcontrib><creatorcontrib>Xu, Cong</creatorcontrib><creatorcontrib>Zhang, Ruonan</creatorcontrib><creatorcontrib>Chen, Bi</creatorcontrib><creatorcontrib>Sui, Xinbing</creatorcontrib><creatorcontrib>Leung, Elaine Lai-Han</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health Medical collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wu, Qibiao</au><au>Yao, Xiaojun</au><au>Chen, Hongwei</au><au>Liu, Zhengtang</au><au>Li, Ting</au><au>Fan, Xingxing</au><au>Zhang, Guilin</au><au>Yu, Lili</au><au>Chen, Min</au><au>Xu, Cong</au><au>Zhang, Ruonan</au><au>Chen, Bi</au><au>Sui, Xinbing</au><au>Leung, Elaine Lai-Han</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term aspirin use for primary cancer prevention: An updated systematic review and subgroup meta-analysis of 29 randomized clinical trials</atitle><jtitle>Journal of Cancer</jtitle><date>2020-01-01</date><risdate>2020</risdate><volume>11</volume><issue>21</issue><spage>6460</spage><epage>6473</epage><pages>6460-6473</pages><issn>1837-9664</issn><eissn>1837-9664</eissn><abstract>Background and objective: Long-term aspirin use for the primary prevention of cancer remains controversial, and variations in the effect of aspirin use on cancer outcomes by aspirin dose, follow-up duration, or study population have never been systematically evaluated. The objective of this study was to evaluate the effect of aspirin on primary cancer prevention and to determine whether the effect differed according to aspirin dose, follow-up duration, or study population. Materials and methods: Seven electronic databases were searched from inception to September 30, 2019. Randomized clinical trials (RCTs) that compared aspirin use versus no aspirin use in participants without pre-existing cancer and reported cancer outcomes were selected. Data were screened and extracted by different investigators. Analyses were performed using Review Manager 5.3 and Comprehensive Meta-Analysis 2.0. Total cancer incidence was defined as the primary clinical endpoint. Total cancer mortality, all-cause mortality, major bleeding, and total bleeding events were the secondary outcomes. Subgroup analyses were conducted based on aspirin dose, follow-up duration, and study populations. Results: Twenty-nine RCTs that randomized 200,679 participants were included. Compared with no aspirin, aspirin use was not associated with significant reductions in total cancer incidence (RR = 1.01, 95% CI: 0.97 to 1.04, P = 0.72), total cancer mortality (RR = 1.00, 95% CI: 0.93 to 1.07, P = 0.90), or all-cause mortality (RR = 0.98, 95% CI: 0.94 to 1.02, P =0.31); however, aspirin use was associated with a 44% increase in the risk of major bleeding (RR = 1.44, 95% CI: 1.32 to 1.57, P < 0.00001) and a 52% increase in the risk of total bleeding events (RR = 1.52, 95% CI: 1.33 to 1.74, P < 0.00001). Subgroup analyses demonstrated consistent results. Conclusions: Long-term aspirin use in individuals without pre-existing cancer was not associated with a significant reduction in total cancer incidence, cancer mortality, or all-cause mortality; however, aspirin use was associated with a significant increase in the risk of bleeding. Therefore, aspirin is not an appropriate choice for the primary cancer prevention.</abstract><cop>Wyoming</cop><pub>Ivyspring International Publisher Pty Ltd</pub><pmid>33033530</pmid><doi>10.7150/jca.49001</doi><tpages>14</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Angina pectoris Aspirin Cancer Diabetes Diabetic retinopathy Disease prevention Heart attacks Hypertension Males Medical screening Meta-analysis Mortality Population Research Paper Stroke Systematic review Tumors |
title | Long-term aspirin use for primary cancer prevention: An updated systematic review and subgroup meta-analysis of 29 randomized clinical trials |
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