COMMENTARY

'Do As I Do: Take Aspirin Daily'

David J. Kerr, CBE, MD, DSc, FRCP, FMedSci

Disclosures

August 30, 2013

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Hello. I am David Kerr, Professor of Cancer Medicine at Oxford, United Kingdom, and Past President of the European Society of Medical Oncology. Great to talk to you all again.

Do you remember from childhood when Mother, or usually Father, said, "Don't do as I do; do as I say." How many of us have been imprinted with that from early childhood? I am going to turn this on its head.

I just returned from a fantastic roundtable discussion on aspirin. This was a selective multidisciplinary meeting with cancer biologists, clinicians, and epidemiologists. Across the spectrum of disease we had neurologists, cardiac specialists, and of course oncologists. We were looking at aspirin as a preventive agent, in terms of primary and secondary prevention. In particular, the data concerning colorectal cancer have become very compelling with regard to aspirin's capacity to prevent primary disease, and to reduce the risk for the disease happening in the first place.[1,2,3]For patients who have had the cancer resected, it appears from observational data and very large cohorts of study, such as those reported by Algra and Rothwell recently in the Lancet,[4] that aspirin can have a remarkable effect in reducing the incidence of subsequent metastasis.

Of interest, though, the improvement and divergence in survival rates and recurrence rates only occurs after 5 years.[5]For the first 5 years of observations, the survival rates and recurrence rates overlap following post-primary dissection of colorectal cancer. Then they start to diverge. That is when something remarkable happens.

There were 2 particular points of discussion at the meeting. One was, what do we do with these data? How do we promulgate them? We may be able to accomplish some important work with the Global Alliance for Chronic Diseases, with WHO (World Health Organization) promulgating the wider, safer use of low-dose aspirin.

Second, how do we respond to that as individuals? This is where I turn my father's missive on its head. "Don't do as I say. Do as I do." I came back from the meeting and I have now started to take low-dose aspirin, 100 mg daily, because the data were so compelling that as an individual I feel moved to do this. Of course I eat my greens. Of course I will try to do my 3 ×30 minutes of decent exercise a week. Of course I have a set of moderately complex reasons for wanting to live a bit longer. Aspirin will be part of my compendium for doing that.

If you want a better, healthier, longer life with a reduced risk for colorectal cancer, don't do as I say; do as I do. Perhaps I can convince you that it is worthwhile to take low-dose aspirin.

As always, thanks for listening. I would be very happy to answer any comments that you make here to me or to post. For now, Medscapers, ahoy! Thank you.

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