Aspirin

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This section does not replicate the other information on this topic but provides additional details or context most relevant to professionals.

Modes of action: platelet activity and the NF-κB pathway

Aspirin reversed or inhibited the activity of platelets promoting colorectal or pancreatic cancer cell proliferation and metastasis.¹Mitrugno A, Sylman JL et al. Aspirin therapy reduces the ability of platelets to promote colon and pancreatic cancer cell proliferation: implications for the oncoprotein c-MYC. American Journal of Physiology. Cell Physiology. 2017 Feb 1;312(2):C176-C189; Patrignani P, Patrono C. Aspirin, platelet inhibition and cancer prevention. Platelets. 2018 Dec;29(8):779-785. 

Aspirin’s inhibition of cyclooxygenases inhibits tumor growth through modulation of the NF-κB pathway.²Chen J, Stark LA. Aspirin prevention of colorectal cancer: focus on NF-κB signalling and the nucleolus. Biomedicines. 2017 Jul 18;5(3). pii: E43. 

Interactions with polymorphisms

Aspirin interacted with rs6983267 regarding colorectal cancer risk. “Homozygous carriers of the variant allele of rs6983267 (ca. 25% of the population) halved their risk for CRC by aspirin use compared to homozygous wildtype carriers who did not benefit from aspirin intake.”³Andersen V, Vogel U. Systematic review: interactions between aspirin, and other nonsteroidal anti-inflammatory drugs, and polymorphisms in relation to colorectal cancer. Alimentary Pharmacology & Therapeutics. 2014 Jul;40(2):147-59.

Aspirin’s impact on fecal immunochemical test results

Use of aspirin lowers FIT sensitivity and specificity regarding advanced neoplasia.⁴Han Z, Nan X et al. Effect of aspirin, warfarin, and proton-pump inhibitors on performance of fecal immunochemical test in colorectal cancer screening: a systematic review and meta-analysis. Clinical and Experimental Medicine. 2023 Dec;23(8):4355-4368; Pang SJ, Lin ZP et al. Impact of antithrombotic drugs on the accuracy of fecal occult blood testing for advanced colorectal neoplasia screening: a meta-analysis and systematic review. Zeitschrift fur Gastroenterologie. 2023 Mar;61(3):297-306; Jung YS, Im E, Park CH. Impact of antiplatelet agents and anticoagulants on the performance of fecal immunochemical tests: a systematic review and meta-analysis. Surgical Endoscopy. 2022 Jun;36(6):4299-4311. However, researchers note that “aspirin discontinuation before FIT to reduce false-positive results should be interpreted with caution given concerns about cardiovascular events. Increasing cutoff values of FIT in aspirin users may be another possible approach.”⁵Han Z, Nan X et al. Effect of aspirin, warfarin, and proton-pump inhibitors on performance of fecal immunochemical test in colorectal cancer screening: a systematic review and meta-analysis. Clinical and Experimental Medicine. 2023 Dec;23(8):4355-4368.

Preclinical evidence 

Notable preclinical evidence is presented here. Clinical evidence is summarized in How can aspirin help you? What the research says ›

Improving treatment outcomes

• Ovarian cancer: phosphatidylcholine-associated aspirin (aspirin-PC) showed anticancer effects in cells and reduced ovarian cancer growth by 50 percent to 90 percent in animals, with no detectable gastrointestinal toxicity; the effect was enhanced in combination with bevacizumab (Avastin) or B20.⁶Huang Y, Lichtenberger LM et al. Antitumor and antiangiogenic effects of aspirin-PC in ovarian cancer. Molecular Cancer Therapeutics. 2016 Dec;15(12):2894-2904.

Body terrain (immune function)

• Improved antitumor immune response and tumor eradication with aspirin combined with anti-PD1 monoclonal antibody in preclinical studies⁷Fong W, To KKW. Drug repurposing to overcome resistance to various therapies for colorectal cancer. Cellular and Molecular Life Sciences. 2019;76(17):3383–3406; Zelenay S, van der Veen AG et al. Cyclooxygenase-dependent tumor growth through evasion of immunity. Cell. 2015 Sep 10;162(6):1257-70.