Aspirin; the wonder drug?

Dr Liz Walder | 15 May 2017

Alongside its analgesic properties, recent reports suggest that aspirin may prevent or even treat cancer. What makes this drug so multi-talented?

How it all began

Aspirin first came to market in 1897. Developed by the pharmaceutical company Bayer from an extract of willow bark, it was thought to be the miracle cure which could treat all ailments. By modifying salicylic acid, previous side effects such as nausea diminished and aspirin (acetylsalicylic acid) was born. Effective in treating rheumatism, relieving headaches, toothache and nerve pain and in reducing fever and inflammation, it was initially prescribed as a powder. Once compressed into a water soluble tablet it became the first major drug to be sold in tablet form.

Overnight sensation

Doctors across the world found that aspirin worked in a broad range of indications including pleurisy, tonsillitis, bladder inflammation and joint pain due to tuberculosis, gonorrhoea and gout. Overnight, aspirin became a world-wide phenomenon and a common household name. It was even included in the Apollo astronauts’ self-medication kits in 1969 to relieve the pain they could encounter with long periods of immobility in their mission to reach the moon.

Analgesic and anti-clotting properties

In addition to its analgesic properties, aspirin is also an effective antiplatelet agent. Daily low-dose aspirin is now used to reduce the risk of blood clotting in certain conditions such as patients who have had a heart attack or stroke. It is also sometimes considered in patients at high risk of a having a heart attack or stroke i.e. patients with high blood pressure. Long-term aspirin use is linked to an increased risk of bleeding in the brain and gut. The risk of these adverse events was originally thought to be low, but recent studies have put the increased risk of gastrointestinal bleeding as high as 55%, with a 54% increased relative risk of intracranial bleeding. Experts therefore believe that the risk of bleeding must be assessed alongside net clinical benefit, especially when used for prevention in high-risk patients.

Anti-cancer agent?

Mounting evidence indicates that aspirin could have anti-cancer effects. Taking a low dose aspirin for five years may halve the risk of developing colon cancer and significantly improve survival rates for oesophageal cancer and lung cancer. In addition, research has shown that aspirin may reduce the risk of cancer spreading to other parts of the body. However, this research is controversial and doctors are advising that patients talk to their GPs before taking aspirin as a preventative measure because of the possible risks of bleeding in the brain and gut.

Do the benefits outweigh the risks?

Aspirin has been around for centuries and its analgesic and anti-clotting properties make it a very sought after drug. Even after all these years investigators are still investigating its wonder properties. For example, a 2012 study showed that aspirin could slow down cognitive decline in elderly women at high risk of cardiovascular disease. Another study has suggested a possible benefit in patients who are at a high risk of stroke after having a total hip replacement. It is thought a soluble aspirin may help to reduce this risk.

So, what is the right course of action?

In my personal opinion, I feel the decision to prescribe aspirin should stay firmly in doctors’ hands. I believe that even though it was deemed to be the wonder drug of the 20th century and is still a household name in the present day, more studies are needed to clarify the exact risks associated with long-term aspirin use. Further clarification is also needed over aspirin’s possible anti-cancer properties before it is prescribed as a preventative agent and patients make the choice to take it. For me the risks are just too unknown.