Aspirin use and endometrial cancer risk and survival

Tsuyoshi Takiuchi; Erin A Blake; Koji Matsuo; Anil K Sood; Theodore M Brasky

doi:10.1016/j.ygyno.2017.10.026

Aspirin use and endometrial cancer risk and survival

Gynecol Oncol. 2018 Jan;148(1):222-232. doi: 10.1016/j.ygyno.2017.10.026. Epub 2017 Nov 11.

Authors

Tsuyoshi Takiuchi¹, Erin A Blake¹, Koji Matsuo², Anil K Sood³, Theodore M Brasky⁴

Affiliations

¹ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
² Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA. Electronic address: koji.matsuo@med.usc.edu.
³ Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Center for RNA Interference and Non-Coding RNAs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁴ Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.

Abstract

The role of acetylsalicylic acid (aspirin) as a chemo-preventive and adjuvant therapeutic agent for cancers is generating attention. Mounting evidence indicates that aspirin reduces the incidence and mortality of certain obesity-related cancers, particularly colorectal cancer. In endometrial cancer, previous studies examining the effect of aspirin remain inconsistent as to the reduction in the risk of endometrial cancer. While some evidence indicates protective effects in obese women, other studies have showed a potential deleterious effect of these medications on endometrial cancer outcomes. However, exposure measurement across studies has been inconsistent in recording dose, duration, and frequency of use; thus making comparisons difficult. In this article, we review the evidence for the association between endometrial cancer and obesity, the pharmacological differences between regular- and low-dose aspirin, as well as the potential anti-tumor mechanism of aspirin, supporting a possible therapeutic effect on endometrial cancer. A proposed mechanism behind decreased cancer mortality in endometrial cancer may be a result of inhibition of metastasis via platelet inactivation and possible prostaglandin E₂ suppression by aspirin. Additionally, aspirin use in particular may have a secondary benefit for obesity-related comorbidities including cardiovascular disease in women with endometrial cancer. Although aspirin-related bleeding needs to be considered as a possible adverse effect, the benefits of aspirin therapy may exceed the potential risk in women with endometrial cancer. The current evidence reviewed herein has resulted in conflicting findings regarding the potential effect on endometrial cancer outcomes, thus indicating that future studies in this area are needed to resolve the effects of aspirin on endometrial cancer survival, particularly to identify specific populations that might benefit from aspirin use.

Keywords: Aspirin; Endometrial cancer; Review; Risk; Survival.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Aspirin / administration & dosage*
Dose-Response Relationship, Drug
Endometrial Neoplasms / drug therapy
Endometrial Neoplasms / mortality*
Female
Humans

Substances

Aspirin

Grants and funding

P30 CA014089/CA/NCI NIH HHS/United States