In recent years, there’s been a lot of talk about the potential benefits, and risks, of a regular regimen of low-dose aspirin. While much of the discussion has centered on whether taking low-dose aspirin can head off cardiovascular disease, some of the focus has also been on breast cancer. Can regular doses of this over-the-counter pain reliever reduce your risk of this common cancer?
For a while there were hints that the evidence was leaning that way. Back in 2017, this area of research, while still inconclusive, was somewhat promising. For example, a 2017 study published in Breast Cancer Research found that among some 57,000 women, those who reported taking low-dose aspirin (81 mg) at least three times a week had a 16% lower risk of breast cancer over all and a 20% lower risk of a specific type of hormonally driven breast cancer.
But the picture shifted in 2018, when three new studies came out and splashed some cold water on the idea, says Dr. Kathryn M. Rexrode, associate professor of medicine at Harvard Medical School and chief of the Division of Women’s Health at Brigham and -Women’s Hospital.
Although none of the studies were explicitly designed to look at breast cancer, they found that aspirin therapy might not achieve prevention goals, and could potentially cause harm. “After 2018, the data for aspirin and prevention were definitely less rosy,” says Dr. Rexrode.
The Aspirin in Reducing Events in the Elderly (ASPREE) study raised the most concern, says Dr. Rexrode. It included people ages 65 and older who were randomly assigned to take either aspirin therapy or an inactive pill (placebo). Overall death rates were higher in the aspirin group, says Dr. Rexrode, and cancer deaths were a driver behind that difference. “This was the study that made me start de-prescribing aspirin in some cases,” she says. “Until 2018, I think the evidence showed that as long as someone was not at high risk for bleeding, low-dose aspirin therapy was a reasonable strategy.” But this study raised the specter of potential harm, shifting the benefit-to-risk ratio, she says.
Another study that came out that year was ASCEND (A Study of Cardiovascular Events in Diabetes), which presented more concerns. It included people who were at high risk for heart disease because they had diabetes, but who had no cardiovascular problems at the start of the trial. It found that low-dose aspirin’s potential heart-related benefits were overshadowed by the risks, which included serious bleeding in the stomach or brain that in many cases required hospitalization.
A third study in 2018 was the ARRIVE (Aspirin to Reduce Risk of Initial Vascular Events) trial, published in The Lancet. It found that low-dose aspirin didn’t bring any heart or blood vessel benefits to people ages 55 to 60 with moderate risk of cardiovascular disease.
As a result of these studies, some organizations changed their recommendations regarding low-dose aspirin therapy. The American Heart Association (AHA) and American College of Cardiology (ACC) now recommend against the use of low-dose aspirin therapy in people who are healthy and don’t have a history of cardiovascular disease. The change does not apply to people who have had a heart attack or stroke or who have undergone a bypass procedure; the recommendation for these people to take low-dose aspirin therapy is unchanged, according to the AHA and ACC.
Little evidence of benefit
In addition to the issues raised by the 2018 studies, the evidence that low-dose aspirin use reduces the risk of breast cancer is also thin, says Dr. Rexrode. While some studies have shown a benefit, the highest quality and most reliable research studies — randomized trials like the Women’s Health Study — haven’t confirmed this, says Dr. Rexrode.
Without convincing evidence that low-dose aspirin brings benefits, it’s difficult to justify its use when there are potentially serious risks.
Weighing the facts
With this in mind, it’s too early to recommend low-dose aspirin therapy for breast cancer prevention alone.
“We definitely don’t have the kind of data we would want to have to make a population-level decision recommending the use of low-dose aspirin for breast cancer prevention,” says Dr. Rexrode. “To the best of my knowledge, our breast cancer specialists are not recommending the use of aspirin for breast cancer prevention, even in women at high risk. And unless I had more persuasive evidence, I would not make that recommendation to a patient at the moment.”
However, she does note that low-dose aspirin therapy still has value for some specific patients. For example, it might be worth using in those who are at high risk of a type of stroke called ischemic stroke, which is caused by blockage in an artery to the brain — provided they’re not at high risk for bleeding. Low-dose aspirin may also benefit women who have had a heart attack or a stroke due to a blood clot.
How to reduce your risk
So, if the weight of the evidence isn’t behind low-dose aspirin as a means of preventing breast cancer, is there anything you can do to reduce your risk?
While some breast cancer risk -factors are outside of your control — such as your family history or the age you started menstruating or went through menopause — there are some modifiable factors.
The first is alcohol use. To reduce your breast cancer risk, cut back on alcohol, or cut it out entirely. “Research pretty convincingly shows that people who drink more than seven alcoholic drinks a week have a higher risk of breast cancer,” says Dr. Rexrode. And the actual threshold may be far lower — as few as three drinks a week.
Alcohol is processed in the liver, which also plays a major role in hormone synthesis inside the body, she says. Alcohol use may affect this process, driving up levels of the female hormone estrogen in the blood, which experts have identified as a breast cancer risk factor.
Research has shown that estrogen is found in higher levels in the blood of women who drink regularly. Circulating estrogen levels are higher in women who drink seven or more drinks a week, and may even be elevated in women who drink as few as three drinks a week, says Dr. Rexrode. The same effect is seen in men. Men who are heavy drinkers are more likely to develop a condition called gynecomastia, or breast enlargement, from the hormonal effects of alcohol on the body, she says.
“The problem is that we live in a culture where alcohol is very sanctioned. It’s very much a part of the social fabric of our society,” says Dr. Rexrode. As a result, there may be a temptation to ignore or downplay this risk. But while it may be difficult to acknowledge, the link between alcohol and breast cancer is well established.
“Alcohol clearly increases the risk for cancer, and we’re hiding our head in the sand because we don’t want to hear that,” says Dr. Rexrode. “I tell all my women patients that one of the most modifiable breast cancer risk factors is alcohol intake.” The goal should be to stay below seven drinks a week, preferably less. The American Cancer Society now recommends women give up alcohol entirely to reduce cancer risk.
In addition to reducing your alcohol intake, you may also be able to reduce your risk of breast cancer by increasing your physical activity and maintaining a healthy weight, says Dr. Rexrode. Fat cells can produce estrogen, the likely reason for an increased risk of breast cancer in overweight post-menopausal women.
Bible verses for today’s meditation and inspiration: Matthew E. McLaren
Acts 4:18-31 And when they had summoned them, they commanded them not to speak or teach at all in the name of Jesus. But Peter and John answered and said to them, “Whether it is right in the sight of God to give heed to you rather than to God, you be the judge; for we cannot stop speaking about what we have seen and heard.”
2 Chronicles 25:19 “You said, ‘Behold, you have defeated Edom.’ And your heart has become proud in boasting. Now stay at home; for why should you provoke trouble so that you, even you, would fall and Judah with you?”
1 Samuel 2:3 “Boast no more so very proudly, Do not let arrogance come out of your mouth; For the LORD is a God of knowledge, And with Him actions are weighed.
Proverbs 11:2 When pride comes, then comes dishonor, But with the humble is wisdom.
Proverbs 16:5 Everyone who is proud in heart is an abomination to the LORD; Assuredly, he will not be unpunished.
Micah 2:3 Therefore thus says the LORD, “Behold, I am planning against this family a calamity From which you cannot remove your necks; And you will not walk haughtily, For it will be an evil time.
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