Navigating Negative Results, Age, Aging Dynamics, and Equity of The Aspirin Conundrum | Expert Guidance and Insight

Georgetown University’s Lombardi Comprehensive Cancer Center researchers say that a recent study on aspirin’s role in breast cancer treatment highlights important concerns about health equity and aging. The findings, published on April 29, have significant implications for cancer and other disease intervention trials. The researchers outlined their concerns in an editorial that accompanied the study. The study’s focus on aspirin in breast cancer treatment sheds light on critical issues that extend beyond just this particular disease.The JAMA article, titled “The Aspirin Conundrum: Navigating Negative Results, Age, Aging Dynamics and Equity,” discusses the Alliance trial. This trial was initiated due to the discovery that breast cancer survivors who were part of a separate clinical trial for cardiovascular disease and taking aspirin were found to have longer life expectancy. In order to confirm this finding, a phase 3 clinical trial was conducted. Participants with nonmetastatic, high-risk breast cancer were randomly assigned to either receive 300mg of aspirin or a placebo on a daily basis. Unfortunately, the results of the trial were disappointing, leading to the suspension of the study after the first interim safety analysis due to the indication of futility.The study found that aspirin did not reduce the chances of cancer coming back or improve survival rates. The Georgetown researchers, Jeanne Mandelblatt, MD, MPH; Candace Mainor, MD; and Barry Hudson, PhD, examined the trial and raised important questions about the results in their editorial. They noted that despite efforts to include diverse groups in the study, certain subgroups such as racial minorities and those facing high levels of systemic racism may not have been adequately represented. These groups may experience chronic life stressors that impact inflammation and accelerate biological aging.”and contribute to disparities in cancer risk, recurrence and mortality,” they write, pointing out that these individuals may potentially see positive effects from aspirin, an anti-inflammatory medication.

Researchers indicate another concern with this and similar experiments is how the difference between chronological age and biological age could impact the trial’s design and outcomes.

The findings from the Alliance trial “raise the question of whether aspirin’s lack of benefit could be partially attributed to variations in biological age, such as variations in immune and platelet function, inflammatory responses, and interactions between the host and tumor microenvironment,” they write.Careful consideration of the intersectionality of aging, cancer, and disparities will be crucial in designing future oncology and other disease trials to promote health equity. Lastly, the researchers note that clinicians may struggle to incorporate new findings into regular practice due to the lack of intervention efficacy and numerous unanswered questions. Despite the clear negative result for using aspirin to improve invasive disease-free survival among breast cancer survivors, the researchers suggest that oncology and primary care providers may still consider discussing it with patients.