Taking aspirin every day can really prolong your life. I’ve changed my mind after years of skepticism, writes PROFESSOR ROB GALLOWAY

As you might expect, a large part of my job as an ER doctor involves prescribing medications and treatments.

But what you may not expect is that what I prescribe often changes.

That all depends on the latest available evidence: and whether you should take aspirin is a good example.

Until a few months ago, I personally wouldn’t take daily aspirin — nor did I advocate it for patients unless they had specific risk factors, such as a previous heart attack or after a stroke.

This was due to the risk of stomach bleeding. Some studies show that a daily dose increases the risk of bleeding by as much as 50 percent.

This sounds like a lot, but since only one in a thousand patients will experience significant bleeding, it would take two thousand people on aspirin for one additional patient to suffer. And now there is compelling new evidence, recently published in the journal Cancer, that has convinced me that, for me at least, the benefits of a daily 75 mg of ‘baby’ aspirin outweigh this risk.

So I’m taking it every morning now to try to increase my chances of living a longer, healthier life – and I think it’s something you might want to consider too (but make sure you read to the end of this piece, because there are caveats!).

As a doctor, if you change your mind, it doesn’t mean you don’t know your stuff, but when new reliable results or theories emerge, our views should reflect this.

In the last lecture I give to our final year medical students, I implore them to recognize that although they will cease to be medical students, they must never cease to be medical students: since 50 percent of what we have taught they will be wrong end – we just don’t know yet which 50 percent that is.

Aspirin is one of the world’s best-known drugs – not just a painkiller, but a wonderful clot-preventing drug derived from the bark of the willow tree.

However, over the years of working in emergency medicine, I have seen many patients with terrible stomach bleeding related to taking aspirin: in my opinion, this clearly reinforced the idea that unless someone had a specific cardiovascular problem, such as a previous heart attack, the risks of taking aspirin outweighed the benefits of its clot-preventing properties.

Still, new evidence is emerging about the benefits of aspirin, suggesting that it may help prevent some types of cancer, and may increase your chance of survival if you do develop the disease by as much as 20 percent.

If you’re wondering why there isn’t much news about it, remember that aspirin is dirt cheap (just a few cents per 75 mg tablet), so there’s no incentive for drug companies to promote it.

Therefore, the aspirin studies are often not the gold standard of expensive, randomized, controlled trials (where a treatment is compared with a placebo), but observational studies (where we analyze data from large groups of patients, some of whom happen to take aspirin).

So we need to look at these studies in detail. And that’s what a group of statisticians from Cardiff University have now done: publishing a large-scale analysis of 118 observational studies (pooling results from more than a million patients with 18 different types of cancer).

The review, published in November 2023 in the British Journal of Cancer, found that deaths from cancer and any disease fell by 20 percent over the course of the studies in people taking aspirin, compared with those who didn’t use it.

And here’s the most important part: The researchers wrote that ‘reasons against aspirin use include an increased risk of gastrointestinal bleeding, although there appears to be no valid evidence that aspirin is responsible for fatal gastrointestinal bleeding…

‘In conclusion, given the relative safety and beneficial effects of aspirin, its use in cancer appears justified, and the ethical implications of this imply that cancer patients should be informed of the evidence and encouraged to raise the subject with their healthcare team.’

We also now know why aspirin might help – thanks to the new study published in the journal Cancer that I mentioned at the beginning.

Researchers in Italy had noted that the risk of colon cancer spreading was lower in patients who regularly took aspirin. They investigated and found that aspirin increases the number of tumor-infiltrating lymphocytes (TILs) in the cancer areas.

These TILs are specific parts of the immune system that help fight cancer cells.

This was not due to the anti-clotting properties of aspirin that we all know about, but to newly discovered mechanisms: aspirin increased the amounts of a molecule called CD80 in cancer cells. This attracts the TILs to the tumor.

In addition, aspirin increased the number of cytotoxic CD8+ T cells, another powerful tumor-fighting immune cell.

So aspirin is even more of a miracle drug than I realized.

I have now changed the advice I give patients with cancer.

You should consult your doctor about this, but I think the standard position should be that if you have cancer, you should take aspirin (75-100 mg).

That is, unless there is a reason not to do so (for example because you are taking a blood thinner due to conditions such as the heart problem atrial fibrillation; and above the age of 70 there is an increased risk of bleeding and there is evidence that aspirin is not so effective and thus the benefits versus risks for older cancer patients are not as clear).

What about people with suspected cancer who are waiting for a diagnosis? The terribly long waiting lists mean that the cancer has often spread much further than it should when the cancer is eventually identified. Aspirin can help slow the spread of cancer and I believe that the benefits of a 75mg dose far outweigh the risks and it is something to ask your GP if you or any of your loved ones are in this situation located.

The good news is that while pharmaceutical companies are not interested in researching aspirin, the charity Cancer Care UK is leading the way, with a trial to see if it can help prevent cancer recurrence.

In the study, called Add-Aspirin, patients with breast, colon, rectum, stomach and prostate cancer take a placebo or one of two doses of aspirin – 100 mg and 300 mg – for five years: these results will be published in to be published over the next few years. .

If you are being treated for cancer, you can ask your oncologist if you can be recruited into the study (the study is being conducted in hospitals in the UK, Ireland and India – in the UK the largest recruiter is University Hospitals Coventry & Warwickshire ).

Simply participating in a trial – regardless of whether a patient is taking a placebo or an active drug – increases the chances of survival because of better follow-up and care.

The final question is this: Can aspirin prevent cancer at all?

Although the studies are largely observational, there is some evidence that aspirin reduces the risk of colon cancer, especially if you have Lynch syndrome, a genetic condition that increases the risk of several types of cancer, including colon cancer.

However, a 2018 study found that if people over the age of 70 start taking aspirin, it can increase the risk of cancer.

I plan to continue my new 75 mg daily aspirin until age 70. I am at higher risk for colon cancer due to a strong family history and I have the inflammatory bowel disease, ulcerative colitis, which also increases the risk.

So discuss with your doctor what is right for you – don’t self-medicate.

And ultimately, one of the best ways to improve your health is to keep us doctors informed and challenged; We may not know all the latest evidence and you may want to question us so we can give you the best possible individualized advice.

@drrobgalloway