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Aspirin's reduction of cancer risk has been on relatively solid epidemiological footing for a long time, it's simply not a big enough protective effect to balance the risk of bleeds etc:

http://www.uspreventiveservicestaskforce.org/uspstf/uspsasco...

Now, if you were to consider all cancers plus cardiovascular benefit, and target folks who are more likely to benefit and/or less likely to have adverse events, it might be useful. Trying to sort some of this out with genomic data was the subject of my MSc, but I couldn't make it work.

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I worked in biomedical research for a while and few things seem to trigger controversies like Aspirin does. Many MDs believe it's evil and don't condone its use for pretty much anything, but on the other end of the spectrum some medical professionals seem to self-medicate with it religiously.

Personally, I've been taking it for many years, for many reasons. I am genetically predisposed to colorectal cancer and serious cardiovascular problems - both led to the death of many relatives and my father has been battling both for a long time now.

Since my adolescence I've also been a migraine sufferer, which is where I originally "discovered" Aspirin, because it helps lessen the impact like no other substance and over the years I found that regular preventive usage reduces the frequency of bad episodes to below 1/y, which is simply awesome. It's probably important to mention that I got the stomach for it, too, which is something that precludes many people from taking it on a regular basis.

With my anecdotal history in mind and weighing my person risk factors against the known complications (I dread ever being in a serious accident where blood loss becomes an issue), I have elected to take it every day.

Pharmacists are horrified, by the way. "Don't take it for longer than 3 days!" "Wouldn't you prefer Ibu instead? You should."

Aspirin's action (activation etc) is well defined at chemical level. Of course, we probably don't know the entire pharmacokinetic/pharcodynamc action of the drug. But if the patient is not on other drugs that could interact with aspirin (e.g. anticoagulants, β2-blockers, antihypertensives, etc.) why not take half if not one aspirin per day?

Depends on the organism, some tolerate aspirin some ibuprofen, some nimesulid, some only paracetamol.

But Aspirin gas proven itself over the years extremely successfully as an anti-pyretic, analgesic, anticoagulant. That's not common among drugs.

I'll try to speak on behalf of the MDs opposed to the general population using Aspirin at all. I think the main reason is that it's easier to take risks for yourself where you'd be hesitant to exposing someone else to the same risk. And they do have a point.

People with bio/medical knowledge are probably able to recognize signs such as stomach problems and act accordingly, but they can't really expect patients to. Aspirin messes up coagulation beyond belief. While that is a boon to some people, issuing a blanket blessing of the substance means people will die in emergency rooms and on operating tables, people who could have been saved if they weren't on ASS. For most MDs, weighing that statistical certainty against a comparatively fuzzy list of preventive benefits which may or may not be favorable for some patients is not a hard decision to make. Hence the verdict: "don't use it, even though I myself do use it".

Again, accepting this for yourself can be an informed decision, but it's not one you want to make on behalf of the general population.

In my case, it's similar. I judge my risk factors in a way that Aspirin is more likely to prolong my healthy life, but I know there is increased risk of complications in other areas. I have no doubt that 90% of all GPs when asked would categorize my taking 250mg per day as abuse.

"Since my adolescence I've also been a migraine sufferer, which is where I originally "discovered" Aspirin, because it helps lessen the impact like no other substance and over the " Really? I've been a migraine sufferer since adolescence and nothing short of morphine would make any difference.

Perhaps you are not referring to actual "migraines" but simply bad headache (the term gets tossed around loosely a lot but it actually does mean something very specific, not just a headache)?

Yes, really.

I think the misunderstanding here comes from your assumption that I'm using Aspirin as an analgesic, which is incorrect. For me, it drastically reduces the frequency of the attacks, not their severity - but then again, I already said that ;)

Sorry to judge too quickly. I'm sure if you suffer from real migraines you know what I mean about people claiming they have a "migraine" which turns out to be just a headache.

I can say for certain what you describe never worked for me but good for you if you found something.

From the abstract this study finds that taking Asprin from 50-65 should yield a 4% reduction in deaths over a 20 year period. It specifically says that at least for 50-65 year olds, the benefits outweigh the risks of bleeding.

Sweet! I haven't read the article (or even the abstract) yet, glad to hear that they were able to nail down a recommendation. Thanks for letting me know.

You wrote a comment refuting the article's headline before looking at the article itself?

Welcome to the internet.

I meant that I hadn't yet read the original scientific publication [1] (I have now), not that I hadn't read the Guardian piece.

I also wouldn't agree that I was refuting the headline, I was just giving background. The scientific paper is very clear that this is an advance along precisely the lines I said were needed (ie defining a group for whom benefits outweigh harms), but the Guardian piece makes it sound like Aspirin's chemopreventive effect had just been discovered whole cloth.

[1] http://annonc.oxfordjournals.org/content/early/2014/07/30/an...

You know, all of these meta-analyses for years have been turning in estimates of lowering all-cause mortality. It's not new.

The USPSTF recommendation in your link is from 2007, so it may perhaps be out of date.

Also, the recent study directly challenges the USPSTF position [1]:

"The US Preventive Services Task Force (USPSTF) have reported on benefits and harms of aspirin use for prevention of specific diseases like colorectal cancer (CRC) and cardiovascular disease (CVD). However, they have not investigated overall benefits and harms based on all major diseases."

I assume the figure of 130,000 lives saved over 20 years takes into account the increased risk of intestinal bleeding and stroke.

[1] http://annonc.oxfordjournals.org/content/early/2014/07/30/an...

You're right, this work is an advance along precisely the lines I claimed were needed. Time to update my opinion!

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