Aspirin Use Tied to Lower Risk of Stomach Cancer after H. Pylori Eradication

By Will Boggs MD

NEW YORK (Reuters Health) - Using aspirin is associated with a reduced risk of gastric cancer after eradication of Helicobacter pylori infection, researchers from Hong Kong report.

"Although aspirin use has been associated with lower risk of gastric cancer in previous studies, most of these studies did not address the potential confounding effects of H. pylori infection,” said Dr. Wai K. Leung from The University of Hong Kong, Queen Mary Hospital.

“The findings from our study would further support the role of low-dose aspirin in preventing gastric cancer in subjects after eradication of H. pylori, particularly in some high-risk subjects,” he told Reuters Health by email.

Dr. Leung and colleagues used data from the Clinical Data Analysis and Reporting System of the Hong Kong Hospital Authority to investigate the role of aspirin in gastric cancer development in more than 63,600 individuals who had received successful H. pylori-eradication therapy.

Use of aspirin at least once a week was associated with a 70% lower risk of gastric cancer among these individuals (hazard ratio, 0.30; 95% confidence interval, 0.15 to 0.61), the team reports in the Journal of the National Cancer Institute, online January 19.

This translates into an absolute difference of 2.52 fewer gastric cancers per 10,000 person-years among aspirin users. The reduced risk was observed only for non-cardia tumors.

Daily aspirin use was associated with the lowest cancer risk, and higher doses (more versus less than 100 mg) and longer durations of use (versus shorter durations or nonuse) were associated with a lower risk of gastric cancer (all P<0.001).

“In this study that focused on a large cohort of subjects that had received H. pylori eradication therapy, we have demonstrated a dose-, frequency-, and duration-dependent reduction in gastric cancer risk with aspirin use,” Dr. Leung concluded. “The degree of risk reduction by aspirin (HR of 0.3) was actually much higher than previously reported in other studies that included both H. pylori-infected and non-infected subjects.”

“Despite the significant reduction in risk of gastric cancer by aspirin, the potential risk of aspirin particularly on inducing gastrointestinal bleeding should be carefully balanced in individual patient before initiating aspirin for the purpose of chemoprevention,” he said.

Dr. Jack Cuzick from Wolfson Institute of Preventive Medicine, Queen Mary University of London, in the UK, who wrote a linked editorial, told Reuters Health by email, "The most interesting fact was that aspirin was, if anything, a stronger preventive agent after H. pylori was eradiated. This is important for Western countries, where the prevalence of H. pylori is lower.”

“This provides further support for my belief that low-dose aspirin should be offered for 10 years to most individuals aged 50-70 years (almost all without hypertension or risk factors for gastrointestinal bleeding) and that H. pylori testing and eradication does not lower this benefit and will help to limit the major side effect, i.e., gastrointestinal bleeding.”

SOURCES: https://bit.ly/2EpDFZY and https://bit.ly/2o6mqBB

J Natl Cancer Inst 2018.

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