Nature Reviews Clinical Oncology 9, 259-267 (May 2012) | doi:10.1038/nrclinonc.2011.199

Subject Category: Prevention

The role of aspirin in cancer prevention

Michael J. Thun, Eric J. Jacobs & Carlo Patrono  About the authors


Clinical guidelines for prophylactic aspirin use currently only consider the cardiovascular benefits of aspirin, weighed against the potential harm from aspirin-induced bleeding. Daily aspirin use has been convincingly shown to reduce the risk of colorectal cancer and recurrence of adenomatous polyps, but in average-risk populations, these benefits alone do not outweigh harms from aspirin-induced bleeding. Recently published secondary analyses of cardiovascular trials provide the first randomized evidence that daily aspirin use may also reduce the incidence of all cancers combined, even at low doses (75–100 mg daily). This Review considers the general mechanism of action that defines aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) as a class, the specific advantages of aspirin over other NSAIDs for prophylactic use, the current evidence concerning the main health outcomes affected by aspirin use, and the hypothesis that inhibition of platelet activation may mediate both the cardioprotective and cancer-preventive effects of low-dose aspirin. It also considers how even a 10% reduction in overall cancer incidence beginning during the first 10 years of treatment could tip the balance of benefits and risks favourably in average-risk populations.

Author affiliations

M. J. Thun, E. J. Jacobs & C. Patrono
Epidemiology Research Program, American Cancer Society, 250 Williams Street, Atlanta, GA 30303–1002, USA (M. J. Thun, E. J. Jacobs).  Department of Pharmacology, Catholic University School of Medicine, Largo Francesco Vito 1, 00168 Rome, Italy (C. Patrono).

Correspondence to: M. J. Thun

Published online 3 April 2012