Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston, MA 02215, USA.
Ann Intern Med. 2013 Jul 16;159(2):77-85. doi: 10.7326/0003-4819-159-2-201307160-00002.
Recent evidence suggests that daily aspirin use decreases cancer risk, particularly for colorectal cancer, but evidence for alternate-day use is scant.
To examine the association between long-term, alternate-day, low-dose aspirin and cancer in healthy women.
Observational follow-up of a randomized trial.
Female health professionals.
39,876 women aged 45 years or older in the Women's Health Study (ClinicalTrials.gov: NCT00000479), 33 682 of whom continued observational follow-up.
100 mg of alternate-day aspirin or placebo through March 2004, with a median 10-year follow-up. Posttrial follow-up continued through March 2012.
Cancer incidence.
A total of 5071 cancer cases (including 2070 breast, 451 colorectal, and 431 lung cancer cases) and 1391 cancer deaths were confirmed. Over the entire follow-up, aspirin had no association with total (hazard ratio [HR], 0.97 [95% CI, 0.92 to 1.03]; P = 0.31), breast (HR, 0.98 [CI, 0.90 to 1.07]; P = 0.65), or lung (HR, 1.04 [CI, 0.86 to 1.26]; P = 0.67) cancer. Colorectal cancer was reduced in the aspirin group (HR, 0.80 [CI, 0.67 to 0.97]; P = 0.021), primarily for proximal colon cancer (HR, 0.73 [CI, 0.55 to 0.95]; P = 0.022). The difference emerged after 10 years, with a posttrial reduction of 42% (HR, 0.58 [CI, 0.42 to 0.80]; P < 0.001). There was no extended effect on cancer deaths or colorectal polyps. More gastrointestinal bleeding (HR, 1.14 [CI, 1.06 to 1.22]; P < 0.001) and peptic ulcers (HR, 1.17 [CI, 1.09 to 1.27]; P < 0.001) occurred in the aspirin group.
Not all women received extended follow-up, and posttrial ascertainment bias cannot be ruled out. Gastrointestinal bleeding, peptic ulcers, and polyps were self-reported during extended follow-up.
Long-term use of alternate-day, low-dose aspirin may reduce risk for colorectal cancer in healthy women.
最近的证据表明，每日服用阿司匹林可降低癌症风险，尤其是结直肠癌，但关于隔日使用阿司匹林的证据很少。
研究长期、隔日、低剂量阿司匹林与健康女性癌症之间的关系。
一项随机试验的观察性随访。
女性健康专业人员。
39876 名年龄在 45 岁或以上的女性参加了妇女健康研究（ClinicalTrials.gov：NCT00000479），其中 33682 名继续进行观察性随访。
每天服用 100 毫克的隔日阿司匹林或安慰剂，直至 2004 年 3 月，中位随访时间为 10 年。试验后随访持续到 2012 年 3 月。
癌症发病率。
共确诊 5071 例癌症（包括 2070 例乳腺癌、451 例结直肠癌和 431 例肺癌病例）和 1391 例癌症死亡病例。在整个随访期间，阿司匹林与总癌症（危险比 [HR]，0.97 [95%CI，0.92 至 1.03]；P=0.31）、乳腺癌（HR，0.98 [CI，0.90 至 1.07]；P=0.65）或肺癌（HR，1.04 [CI，0.86 至 1.26]；P=0.67）均无相关性。阿司匹林组结直肠癌减少（HR，0.80 [CI，0.67 至 0.97]；P=0.021），主要是近端结肠癌（HR，0.73 [CI，0.55 至 0.95]；P=0.022）。这种差异在 10 年后出现，试验后减少了 42%（HR，0.58 [CI，0.42 至 0.80]；P<0.001）。对癌症死亡或结直肠息肉没有延长的影响。阿司匹林组胃肠道出血（HR，1.14 [CI，1.06 至 1.22]；P<0.001）和消化性溃疡（HR，1.17 [CI，1.09 至 1.27]；P<0.001）的发生率更高。
并非所有女性都接受了延长随访，不能排除试验后随访的偏倚。胃肠道出血、消化性溃疡和息肉是在延长随访期间自我报告的。
长期使用隔日、低剂量阿司匹林可能降低健康女性结直肠癌的风险。
