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K E Y P O I N T S

Breast cancer is the most common form of female cancer - over 40,000 women in the UK are diagnosed each year.

80% of breast cancers occur in women after the menopause.

NSAID stands for non-steroidal anti-inflammatory drugs. It includes drugs such as aspirin and ibuprofen.

Research in America found that the risk of breast cancer in post-menopausal women was 21 per cent lower in woman who took aspirin more than twice a week for five to nine years, and 28 per cent lower if they took it for 10 years or more. Ibuprofen reduced the risk by 49 per cent.

Experts are "interested" in the findings, but feel more research is needed, especially as NSAIDs can cause serious side-effects, such as stomach ulcers and bleeding.

Ways of reducing your cancer risk include eating healthily and being physically active. Being breast aware is a good way of spotting changes quickly and breast screening is available for over 50 year olds.

Could painkillers offer breast cancer protection?

Bupa investigative news - 16 April 2003
written by Rachel Newcombe, reporter for Bupa's Health Information Team

Aspirin and ibuprofen are best known for their painkilling abilities, but according to American researchers, they may also offer breast cancer protection for post-menopausal women. But do they really offer additional benefits? Is it safe to take the drugs regularly, and what do the experts make of this idea?

What were the headlines?

The idea that easily available over-the-counter drugs such as aspirin and ibuprofen could have more than a painkilling effect and offer extra protection against breast cancer was quickly picked up by reporters and gained wide media coverage.

Examples of headlines featured in UK newspapers include, "Aspirin to beat breast cancer," "Over-the-counter painkillers 'halve breast cancer risk," "Aspirin cuts cancer risks," and "The 'dirty' drug that cleans up cancer."

Although ibuprofen actually appeared to have a greater effect, most reports focused solely on aspirin - possibly as previous theories have also associated it with cancer protection - or only gave a tiny mention of ibuprofen.

What is the bigger picture?

Details of the study were published in the Proceedings for the 94th Annual Meeting of the American Association of Cancer Research (AACR).

The data gathered was from the National Cancer Institute's (NCI) Women's Health Initiative (WHI) Observational Study, involving 80,741 post-menopausal women between the ages of 50 and 79 years old. None of the women had reported a history of cancer, other than non-melanoma skin cancer at the start of the study, although 1,392 women subsequently developed breast cancer. Personal interviews were conducted with each of the 80,741 women to gain details of their medical history, lifestyle habits and use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen.

Each individual's probability of developing breast cancer was estimated and adjusted for age and other breast cancer factors, such as body mass, family history and exercise. After analysing the women's lifestyle habits and NSAID taking, they discovered that those who took two or more aspirins per week (considered regularly) for five to nine years reduced their risk of breast cancer by 21 per cent. If they took aspirin regularly for 10 or more years, the risk protection rose to 28 per cent. Users of ibuprofen appeared to get even greater benefits, reducing their breast cancer risk by 49 per cent.

The women with reduced risks were taking standard doses of the pills - 325mg of aspirin and 200mg of ibuprofen. Interestingly, regularly taking low dose aspirin, containing 100mg or less, had no effect.

According to lead investigator, Dr. Randall Harris, from Ohio State University, "These results suggest that even women at high risk for breast cancer may be protected by taking NSAIDs. I have been involved in three previous studies of NSAIDs and breast cancer, all of which showed virtually the same result as this multi-centre national investigation. There have now been fifteen studies, and the combined estimate of reduced breast cancer risk with long term intake of NSAIDs is approximately 30 per cent."

He added, however, that, "Before usage guidelines for NSAIDs can be implemented, additional studies are needed."

This isn't the first time the potential cancer protecting benefits of aspirin have been highlighted. In March 2003, it hit the headlines after studies found it could help prevent cancers of the colon, mouth, throat and oesophagus.

“This research is interesting, however the study has only suggested a link between taking aspirin or ibuprofen and reducing breast cancer risk. Whether the link is causal or coincidental has not been proven. It is too soon to suggest that women should regularly take NSAIDs to lower their risk of breast cancer. Aspirin can cause harmful side effects, such as stomach problems and internal bleeding, so before taking it long-term people need to weigh up the possible risks and benefits. For lowering the risk of breast cancer, the risks of aspirin are well known and the benefits have not been conclusively proven. People should see their own doctor for advice before starting long-term medication.”

Annabel Bentley,
Assistant Medical Director, Bupa

What does this mean?

"This is a very interesting study," said Dr Michelle Barclay, research and policy manager for Breakthrough Breast Cancer. "It has been known for some time that aspirin is beneficial in preventing heart disease and recently there has been more evidence to suggest aspirin may also help reduce the risk of other cancers, including lung, prostate and colon."

"Clearly," she added, "this study is exciting, however we would express caution before recommending that women take aspirin on a daily basis until studies have established the long-term side effects. Any woman with concerns should consult her GP."

Liz Cheesman, a helpline nurse at Breast Cancer Care, welcomed the research but said, "We would like to highlight a level of caution to all women as there is a risk of side effects from taking the NSAIDs."

Dr Richard Sullivan, head of clinical programmes at Cancer Research UK, also took a cautious attitude. "This is very interesting data, but the message from us would be caution. The reality is that we need to know how many women we could really prevent getting breast cancer and how many would suffer serious fatal side effects from taking these drugs."

A C T I O N P O I N T S

Don't start taking aspirin or ibuprofen on a regular basis, unless instructed to do so by your doctor, as they can cause serious adverse effects, such as stomach ulcers and bleeding, and trigger asthma attacks.

Be breast aware, by checking your breasts for changes each month. If you notice anything different or unusual, see a doctor immediately. Particular things to look for include:

a lump in the breast or armpit
a lumpy or thickening area on the breast
a change in the size or shape of the breast
a change in the appearance or direction of the nipple
a discharge that is blood-stained
breast pain that doesn't go away after a period
a change in the skin of the breast, such as dimpling or puckering

Many private health centres offer breast screening to women from the age of 40. If you're between 50 and 64 years, you should be invited to regular free NHS breast screening clinics, sometimes in mobile units, every three years. Women over 65 are able to make an appointment anytime at their local clinic for free screening without receiving an invite.

What does this mean to me?

Dr Richard Sullivan advises against taking regular painkillers of your own accord. "Aspirin and ibuprofen do have adverse reactions - in particular gastrointestinal bleeding which in some cases can be fatal. They can also trigger asthma attacks," he explained.

According to Liz Cheesman, "In the first instance, Breast Cancer Care would advise women to consult their GP before taking any action and to follow the breast awareness five-point code:

know what is normal for you and what to look for and feel for
look at your breasts for any changes
feel your breasts for any changes
talk to your GP straightaway if you find any changes
act by attending routine breast screening if you are over 50."

Cancer Research UK also reinforce the importance of becoming "breast aware" and say, "Over 90 per cent of breast tumours are first noticed by women themselves." They add that other safe factors that may offer protection against the disease are being physically active and consuming a healthy diet.

Summary

The idea that humble painkillers could have extra powers is interesting, However, more research needs to be done to fully determine whether there are benefits and if it's safe for all women to take the drugs regularly. Until then, the advice is to not take aspirin or ibuprofen on a regular basis, unless directed by your doctor, and to remain breast aware.