Solmunde Elisabeth, Pedersen Rikke N, Nørgaard Mette, Mellemkjær Lene, Friis Søren, Ejlertsen Bent, Ahern Thomas P, Cronin-Fenton Deirdre P
Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark.
Br J Cancer. 2025 Jul 22. doi: 10.1038/s41416-025-03112-3.
The anti-cancer potential of low-dose aspirin in long-term breast cancer (BC) survivors remain unknown. We evaluated the association between low-dose aspirin use and BC recurrence and mortality.
Women ≥40 years diagnosed with stage I-III BC (1996-2004) were identified from the Danish Breast Cancer Group (DBCG) database and information on aspirin use from the Danish Prescription Registry. We ascertained recurrences from DBCG and via a validated algorithm. We plotted cumulative incidences of recurrence and mortality, accounting for competing risks. Using Cox regression, we estimated hazard ratios (HRs) and 95% confidence intervals (CI), employing landmark analyses at 5-, 10-, and 15-year post-diagnosis.
Among 20,509 BC survivors, 4527 developed recurrence over 232,441 person-years of follow-up. The 20-year cumulative incidence of recurrence was lower in users (17.8%) than nonusers (22.4%), with similar trends among 10-year disease-free survivors (9.9% vs. 12.7%). We observed reduced HRs of recurrence (adjusted HR = 0.80, (95% CI = 0.66-0.98); HR = 0.87 (0.73-1.05); HR = 0.82 (0.57-1.17) in aspirin users, but increased HRs of all-cause mortality (HR = 1.08 (0.96-1.21); HR = 1.09 (0.96-1.24); HR = 1.09 (0.80-1.31).
The reduced recurrence risk in aspirin users may indicate potential anti-cancer effects of aspirin, though the increased risk of death suggests influence by confounding by indication and competing risks.
低剂量阿司匹林对长期乳腺癌（BC）幸存者的抗癌潜力尚不清楚。我们评估了低剂量阿司匹林使用与BC复发及死亡率之间的关联。
从丹麦乳腺癌组（DBCG）数据库中识别出年龄≥40岁、诊断为I - III期BC（1996 - 2004年）的女性，并从丹麦处方登记处获取阿司匹林使用信息。我们通过DBCG及一种经过验证的算法确定复发情况。我们绘制了复发和死亡率的累积发病率，并考虑了竞争风险。使用Cox回归，我们估计了风险比（HRs）和95%置信区间（CI），在诊断后5年、10年和15年进行了标志性分析。
在20,509名BC幸存者中，4527人在232,441人年的随访中出现复发。使用者的20年累积复发率（17.8%）低于非使用者（22.4%），在10年无病生存者中也有类似趋势（9.9%对12.7%）。我们观察到阿司匹林使用者的复发HRs降低（调整后HR = 0.80，（95% CI = 0.66 - 0.98）；HR = 0.87（0.73 - 1.05）；HR = 0.82（0.57 - 1.17）），但全因死亡率的HRs增加（HR = 1.08（0.96 - 1.21）；HR = 1.09（0.96 - 1.24）；HR = 1.09（0.80 - 1.31））。
阿司匹林使用者复发风险降低可能表明阿司匹林具有潜在抗癌作用，尽管死亡风险增加提示存在指征性混杂和竞争风险的影响。
