Aspirin and Breast Cancer
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GWEN IFILL: Now, can aspirin reduce the risk of breast cancer? A new study says maybe. For the hows and the whys of this new finding, we turn to one of the study’s lead researchers, Dr. Alfred Neugut. He’s the co-director of the cancer prevention program at New York Presbyterian Hospital. Welcome, Dr. Neugut.
DR. ALFRED NEUGUT: Thank you.
GWEN IFILL: Based on the results we’ve seen from the study today, how much low ser the risk for women of a certain age or with a certain tendency who take aspirin to get breast cancer?
DR. ALFRED NEUGUT: We found that overall taking aspirin reduced the risk by approximately 20 percent. If the aspirin was taken on a regular basis, we estimated about a 25, 26 percent reduction in the risk of breast cancer, but more importantly, we found that for a specific type of breast cancer, hormone receptor-positive breast cancer or estrogen-dependent breast cancer, women who took aspirin on a regular basis had a about almost a 30 percent reduction in the risk of breast cancer.
GWEN IFILL: Now, how do we know what a hormone-dependent cancer is? What is that?
DR. ALFRED NEUGUT: That’s actually about 70 to 75 percent of breast cancers are hormone-receptor positive. These primarily occur in women who are post-menopausal. These are the type of breast cancers that are treated with Tamoxifen and other hormones when women get breast cancer. What we suspect is happening is that the aspirin acts in this instance by a mechanism by which it reduces the levels of estrogens in the breast and thereby prevents the breast, these specific types of breast cancer from occurring.
GWEN IFILL: Now we have heard about all of the good things that baby aspirin can do for you every day. We’ve heard that it might reduce the chance of colorectal cancer, it might reduce the chance of cardiac disease, but we’ve never heard, or at least in the larger community we have not heard about it having to do with breast cancer. What is it about aspirin that makes it kind of almost a miracle drug that it can have so many benefits across so many different platforms?
DR. ALFRED NEUGUT: Well, the information with regard to aspirin and breast cancer is really, as you say, fairly recent. It’s really only been accumulating over the last two, three, maybe a few more years than that. The evidence with regard to cardiovascular disease goes back ten, fifteen or more years, and with regard to colon cancer and GI tract cancer, it’s ten or fifteen years.
With regard to… it acts in a number of ways. Some ways it should be remembered are bad for you. It can cause G.I. upset and pep tick ulcers and G.I. bleeding. Again, based on our study and certainly in general, one shouldn’t run right out and start popping aspirin pills purely to reduce the risk of breast cancer, but aspirin does act in a number of different directions on a number of different enzymes and different ways in the body.
In many ways it is a miracle drug. It acts as an analgesic for headaches and for arthritis. It acts to reduce platelet aggregation, and that’s in which it reduces your risk of cardiac disease. It can act to reduce your risk of G.I. tract cancer, and this is a new mechanism we think we’re seeing now whereby it can reduce your risk of breast cancer.
GWEN IFILL: Is there anything in this study which would tell someone who was thinking about this treatment how many pills you have to take, how much, whether it affects a certain subset of women disproportionately?
DR. ALFRED NEUGUT: Well, we did find that a woman does have to take the aspirin regularly, that is, we believe almost every day in order to really see the benefit. We did not have information on the dose of the pill, so while in the context of heart disease a baby aspirin a day seems to be adequate, we really don’t have any dose information.
GWEN IFILL: As a matter of fact, the way the study was taken, I understand, it was asking women to– it was asking women in the study the recall how much they’d taken.
DR. ALFRED NEUGUT: That’s right.
GWEN IFILL: They didn’t actually monitor someone’s dosage?
DR. ALFRED NEUGUT: Well, right. This was a study that was done in 1996. So at that time, there was really no studies that had shown that there was any association between aspirin use and breast cancer. At the time there had been several studies showing an association with colon cancer, so we were doing a study of ideologic factors for breast cancer. We thought it would be wise to include questions about the use of aspirin, perhaps hypothesizing that we’d be lucky and see if there might turn out to be an association with aspirin, as well. And indeed it turned out to be the case. Unfortunately we didn’t include questions about in more detail – about the dosage of the pills.
GWEN IFILL: When you talk about aspirin, for a lot of people it’s interchangeable with something like Advil which is ibuprofen or something like Tylenol which is acetaminophen. Is there any way of nose whether those pain relievers might have the same effect as aspirin in this case?
DR. ALFRED NEUGUT: We had information on ibuprofen, which is Motrin or Advil. Fewer women used those types of pills I suppose for arthritis or other pain relief, and so while there was a tendency, a trend that showed a reduction in the incidents of breast cancer, I would say that the information wasn’t adequate to draw a firm conclusion with regard to the benefit of the pills.
With regard to Tylenol, that acts as an analgesic, as a painkiller, in entirely different mechanisms than aspirin does, and showed no benefit whatsoever, which is reassuring to us because it suggests to us that the benefit of the aspirin really was on the basis of its non-steroidal anti-inflammatory drug activities. It’s cyclooxygenase, which is the method by which the aspirin works.
GWEN IFILL: You’re telling me women with worried about having a propensity toward cancer should not be rushing out to stock up on aspirin yet?
DR. ALFRED NEUGUT: No, I don’t think so. If a woman is already taking aspirin for cardiac disease prevention, that maybe she’s going to get a little extra bang for the buck from the aspirin that she is using, but again, remember that aspirin does have significant toxicities and if she is at increased risk for breast cancer or is looking for ways to prevent getting breast cancer, she should really consult her physician and look at the other ways in which we already know that there are effective mechanisms for reducing the risk of breast cancer or mortality from breast cancer.
GWEN IFILL: Dr. Alfred Neugut, thank you very much for helping us out.
DR. ALFRED NEUGUT: Thank you for having me.