EXPERT REACTION: Taking aspirin regularly may lower risk of ovarian cancer regardless of genetic risk

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Meta-analysis: This type of study involves using statistics to combine the data from multiple previous studies to give an overall result. The reliability of a meta-analysis depends on both the quality and similarity of the individual studies being grouped together.

Systematic review: This type of study is a structured approach to reviewing all the evidence to answer a specific question. It can include a meta-analysis which is a statistical method of combining the data from multiple studies to get an overall result.

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Using aspirin regularly may help lower women's risk of ovarian cancer, regardless of whether they are more genetically susceptible or not, according to Australian and international research. The research, which grouped together 8 previous studies, found that having known genetic variants linked to ovarian cancer doesn't appear to impact the protection women get from taking aspirin daily or almost daily use for 6 months or longer. Across the board, women who took aspirin frequently had around a 13% lower risk of ovarian cancer. 

Journal/conference: JAMA Network Open

Link to research (DOI): 10.1001/jamanetworkopen.2023.0666

Organisation/s: QIMR Berghofer Medical Research Institute, The University of Queensland, The University of New South Wales, National Cancer Institute, USA

Funder: This study was funded by grant W81XWH-19-1-0346 from the DoD Ovarian Cancer Research Program. The Ovarian Cancer Association Consortium was supported by a grant from the Ovarian Cancer Research Fund thanks to donations from the family and friends of Kathryn Sladek Smith. The Australian Ovarian Cancer Study and the Australian Cancer Study were funded by grant DAMD17-01-1-0729 from the US Army Medical Research and Material Command; grants 199600 and 400413 from the National Health and Medical Research Council of Australia; grants from the Cancer Councils of New SouthWales, Victoria, Queensland, South Australia, and Tasmania; and grants from the Cancer Foundation ofWestern Australia. The Diseases of the Ovary and Their Evaluation Study was funded by grants R01 CA112523 and R01 CA87538 from the NCI. The Hawaii Ovarian Cancer Case-Control Study was funded by grants R01 CA58598, N01 CN55424, and N01 PC67001 from the NCI. The Hormones and Ovarian Cancer Prediction Study was funded by grant R01 CA95023 from the NCI and grant DAMD17-02-1-0669 from the DoD. The North Carolina Ovarian Cancer Study was funded by grant R01 CA76016 from the NCI and grant DAMD17-02-1-0666 from the DoD. The University of California, Irvine Ovarian Cancer Study was funded by grants R01 CA58860 and R01 CA92044 from the NCI and grant LVS-39420 from the Lon V Smith Foundation. The UK Ovarian Cancer Population Study was funded by CRUK, the Eve Appeal, and the OAK Foundation. The University of Southern California Study of Lifestyle andWomen’s Health was funded by grants R01 CA17054, R01 CA14089, R01 CA61132, N01 PC-67010, and P01 CA17054 from NIH as well as by grants 00-01389V-20170, R03 CA113148, R03 CA115195, and N01 CN25403 from the NIH and grant 2II0200 from the University of Southern California to the California Cancer Research Program. Additional funding was provided by the Huntsman Cancer Institute (Dr Trabert), grant K07-CA80668 from the NCI (Dr Modugno), and grant DGE-2217399-FM from the US National Science Foundation (Dr Modugno).

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Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Associate Professor Alex Polyakov is a Clinical Associate Professor at the Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne and a Consultant Obstetrician, Gynaecologist and Fertility Specialist at the Royal Women's Hospital, Melbourne. He is a Medical Director of Genea Fertility Melbourne.

This study examined whether genetic factors modify the association between frequent aspirin use and ovarian cancer risk. The researchers pooled individual-level data from eight population-based case-control studies and included patients and control participants with genetic data and data on frequent aspirin use. The study found that frequent aspirin use was associated with a 13% reduced risk of nonmucinous epithelial ovarian cancer, but the polygenic score (PGS) for nonmucinous ovarian cancer did not modify this association. These results suggest that inherited genetic susceptibility to ovarian cancer based on currently identified common genetic variants does not affect the protective association between frequent aspirin use and ovarian cancer.

The study's findings suggest that aspirin could potentially be used as a chemopreventive agent for ovarian cancer. However, the risk of serious adverse events, such as gastric ulcer and hemorrhagic stroke, and the low incidence of ovarian cancer in the general population limit its use. The authors suggest that future research should continue to explore the role of aspirin use for ovarian cancer prevention in higher-risk individuals, identified by their family history or PGS screening, to improve the risk-benefit profile.

Long-term aspirin use has been associated with an increased risk of gastrointestinal bleeding and ulcers. Furthermore, long-term aspirin use can increase the risk of hemorrhagic stroke, a type of stroke caused by bleeding in the brain. Although the risk of these adverse events is low, they can be serious and potentially life-threatening. Aspirin can also interact with other drugs and increase the risk of bleeding.

The study has significant limitations, including the retrospective case-control design, potential confounding and recall bias, and the inability to test for effect modification by pathogenic variants. However, the researchers carefully adjusted for known potential confounders, and case-control and prospective cohort risk estimates of the association of aspirin with ovarian cancer were similar in their previous study, suggesting minimal recall bias.

Considering the aspirin’s ability to reduce the risk of ovarian cancer and possible complications of its long-term use, it is unclear whether the benefit gained by aspirin use in this setting will provide an overall advantage on the population level or for individuals at a heightened risk of developing ovarian cancer. Further research aimed at identifying the mechanisms behind the reduced risk of ovarian cancer by aspirin use are urgently required and may provide future directions to develop preventive pharmacological interventions.

Last updated: 18 Aug 2023 12:19pm
Declared conflicts of interest:
None declared.

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