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Aspirin gets some respect

Imagine a new drug that could reduce the likelihood of developing several life-threatening kinds of cancer. As a bonus, the same medication might dramatically lower the risk of having a heart attack. For good measure, this compound would perhaps help prevent a serious complication of pregnancy called pre-eclampsia.

If such a drug were to be discovered today, the manufacturer might well charge thousands of dollars a month for it. That's how much drug companies are charging these days for their newest breakthroughs. In any event, it's a safe bet it would be pricey.

You might be surprised to learn that there actually is such a drug, but it costs only pennies a day. It doesn't get nearly as much attention as a brand-new drug would, perhaps because it is more than 100 years old and available without a prescription. The drug is acetylsalicylic acid, commonly known as aspirin.

A recent meta-analysis reviewed the data from eight studies that included more than 25,000 patients (The Lancet online, Dec. 7, 2010). Over approximately five years, people who took as little as 75 mg of aspirin a day cut their chances of dying from digestive-tract cancers roughly in half.

The benefits in several other cancers were less dramatic but still statistically significant: brain, lung and prostate cancer death rates also dropped, especially for adenocarcinomas. People older than 65 got the greatest benefit. The longer people took aspirin, the better it worked.

In an unrelated study published around the same time, German physicians found that a common test to screen for colorectal cancer is more accurate in people taking low-dose aspirin (Journal of the American Medical Association, Dec. 8, 2010).

This study compared the results of a fecal occult blood test with the "gold-standard" results of a colonoscopy. The investigators had undertaken this study because they worried that aspirin might interfere with the accuracy of a test that looks for blood in stool. After all, aspirin can cause intestinal bleeding. Instead they found that aspirin doubled the accuracy of the stool test, allowing it to detect 70 percent of colon tumors found in colonoscopies.

Is there a downside to this miraculous medication? Aspirin does have some drawbacks. Part of its recognized benefit in preventing heart attacks and strokes is probably due to its action on blood platelets. When platelets clump together, they form blood clots that are potentially quite dangerous in arteries. But when aspirin prevents them from clumping together, tiny injuries inside the body may lead to dangerous bleeding.

The most common serious complication of aspirin is bleeding ulcers. This can be a life-threatening problem. Less common but equally dangerous is the risk of bleeding stroke. Aspirin also can interact with many other drugs. That's why people taking it long term should be under medical supervision.

Despite its drawbacks, investigators now believe that aspirin truly is a wonder drug. A medication that can reduce the risk of our two biggest killers -- cancer and heart disease -- for pennies a day deserves a lot of respect.

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