One swallow does not make a summer.

Aspirin + pancreatic cancer. (NCBI)

For

• Study published and widely reported in the news.

I am unaware of the reasons why the women used aspirin and any co-morbidity (other illnesses or factors).  These may themselves be factors which either enhance any risk of aspirin causing pancreatic cancer or are an independent risk, with concomitant aspirin use a red herring.  No pathogenesis was suggested as to how aspirin would cause the maliganancy.  As they cleverly cover themselves, many more studies are needed.  Either sloppy reporting by the media or sloppy presentation led to very misleading headlines.  Personally I imagine it's a little of both. 

Against

Full text

1.  Regular use of aspirin and pancreatic cancer risk.  Menezes RJ, Huber KR, Mahoney MC, Moysich KB. BMC Public Health. 2002; 2(1): 18. PMCID: 126211 <Link>  Background Regular use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) has been consistently associated with reduced risk of colorectal cancer and adenoma, and there is some evidence for a protective effect for other types of cancer. As experimental studies reveal a possible role for NSAIDs is reducing the risk of pancreatic cancer, epidemiological studies examining similar associations in human populations become more important. Methods In this hospital-based case-control study, 194 patients with pancreatic cancer were compared to 582 age and sex-matched patients with non-neoplastic conditions to examine the association between aspirin use and risk of pancreatic cancer. All participants received medical services at the Roswell Park Cancer Institute in Buffalo, NY and completed a comprehensive epidemiologic questionnaire that included information on demographics, lifestyle factors and medical history as well as frequency and duration of aspirin use. Patients using at least one tablet per week for at least six months were classified as regular aspirin users. Unconditional logistic regression was used to compute crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results Pancreatic cancer risk in aspirin users was not changed relative to non-users (adjusted OR = 1.00; 95% CI 0.72–1.39). No significant change in risk was found in relation to greater frequency or prolonged duration of use, in the total sample or in either gender. Conclusions These data suggest that regular aspirin use may not be associated with lower risk of pancreatic cancer.

2.  Effect of anti-inflammatory drugs on overall risk of common cancer: case-control study in general practice research database.  Langman MJ, Cheng KK, Gilman EA, Lancashire RJ.  BMJ. 2000 Jun 17; 320(7250): 1642-1646. PMCID: 27410. <Link>

Objective: To examine whether anti-inflammatory drug treatment protects against the commoner cancers in the United Kingdom.

Design: Case-control study using the general practice research database.

Setting: Practices throughout United Kingdom providing data to the database.

Subjects: 
Patients who had a first diagnosis of five gastrointestinal (oesophagus, stomach, colon, rectum, and pancreas) cancers and four non-gastrointestinal (bladder, breast, lung, and prostate) cancers in 1993-5 for whom prescription data were available for the at least the previous 36 months. Each case was matched for age, sex, and general practice with three controls.

Main outcome measure: Risk of cancer.

Results: 
In 12 174 cancer cases and 34 934 controls overall risk of the nine cancers was not significantly reduced among those who had received at least seven prescriptions in the 13-36 months before cancer diagnosis (odds ratio 0.98, 95% confidence interval 0.89 to 1.07). Findings were nevertheless compatible with protective effects from anti-inflammatory drugs against cancers of the oesophagus (0.64, 0.41 to 0.98), stomach (0.51, 0.33 to 0.79), colon (0.76, 0.58 to 1.00), and rectum (0.75, 0.49 to 1.14) with dose related trends. The risk of pancreatic cancer (1.49, 1.02 to 2.18) and prostatic cancer (1.33, 1.07 to1.64) was increased among patients who had received at least seven prescriptions, but the trend was dose related for only pancreatic cancer.

Conclusions: 
Anti-inflammatory drugs may protect against oesophageal and gastric cancer as well as colon and rectal cancer. The increased risks of pancreatic and prostatic cancer could be due to chance or to undetected biases and warrant further investigation.

3.  Lipoxygenase and cyclooxygenase metabolism: new insights in treatment and chemoprevention of pancreatic cancer.  Ding XZ, Hennig R, Adrian TE.  Mol Cancer. 2003; 2(1): 10.  PMCID: 149414. <Link>

Abstract.

The essential fatty acids, linoleic acid and arachidonic acid play an important role in pancreatic cancer development and progression. These fatty acids are metabolized to eicosanoids by cyclooxygenases and lipoxygenases. Abnormal expression and activities of both cyclooxygenases and lipoxygenases have been reported in pancreatic cancer. In this article, we aim to provide a brief summary of (1) our understanding of the roles of these enzymes in pancreatic cancer tumorigenesis and progression; and (2) the potential of using cyclooxygenase and lipoxygenase inhibitors for pancreatic cancer treatment and prevention.

Keywords: pancreatic cancer, cyclooxygenase, lipoxygenase

Other journal citations-

• Aspirin may lower risk of pancreatic cancer.  Hitt E.  Lancet Oncol. 2002 Sep;3(9):518.
• Epidemiology of non-steroidal anti-inflammatory drugs and cancer.  Baron JA.  Prog Exp Tumor Res. 2003;37:1-24.
  
  There is evidence that aspirin--and apparently other NSAIDs--may be protective agents against cancer in the gastrointestinal tract. These effects are particularly well documented in the colon and rectum. Even considered in isolation, the observational data regarding colorectal neoplasia are quite strong, and the reality of a protective effect is buttressed by clinical trial data showing that aspirin prevents sporadic adenomas. Furthermore, the NSAIDs sulindac celecoxib have actually led to the regression of existing colorectal polyps in patients with FAP. Clearly, NSAIDs have the potential to suppress carcinogenesis in the large bowel. Observational data suggesting inverse associations of NSAIDs with cancers of the stomach and esophagus have emerged from several case-control studies and a few cohort analyses.

In some studies the findings display features often associated with causal relationships, for example decreasing risks with increasing doses or duration of use. Nonetheless, the data currently do not support a secure conclusion that NSAIDs protect against these malignancies. The relevant data are not nearly as extensive as those for the colorectum, and case-control investigation of these upper gastrointestinal sites may be particularly delicate. It is conceivable that early symptoms of cancer (or of pre-invasive lesions) may have discouraged NSAID use in the cancer patients, creating the appearance of a protective association of the drugs with the risk of these malignancies. More extensive observational data particularly from cohort studies would be desirable to confirm the existing findings and clarify the doses and durations of use required for an effect. Clinical trial investigation might also be practical for pre-neoplastic endpoints, or--in carefully selected populations--perhaps with cancer as the focus. There are only relatively limited data available regarding the effect of NSAIDs on cancer of the pancreas. However, the studies that have investigated this malignancy have reported indications that NSAIDs may have a protective effect. The effects of NSAIDs on cancers outside the gastrointestinal tract are not clear. Some investigations suggest that NSAID use, particularly aspirin, is inversely associated with risk of cancers of the breast or ovary, but several well-done studies have not seen these associations, and the observations could have been due to bias or confounding.

Findings regarding prostate cancer are similarly conflicting. The urinary tract is one organ system in which several studies have reported an increased cancer risk in association with NSAID use.  Nonetheless, the effects remain unclear.  There is only limited available information regarding carcinoma of the bladder, and no firm conclusions can be drawn at this point. More extensive data have been generated regarding the effect of NSAIDs--largely salicylates--on renal cell carcinoma or cancer or the renal pelvis and ureter.  Although some studies have reported increased risks, there are also findings suggesting no association. It is particularly difficult for observational studies to ascertain with confidence the true effects of aspirin because of the suspected relationship of these cancers with use of phenacetin and perhaps acetaminophen. Further data--particularly from careful and large cohort studies--would be important to clarify these issues. As a body of research, the findings discussed here from epidemiological studies and clinical trials have begun to clarify the effect of NSAIDs on carcinogenesis in various organs in humans. There is clear potential for protective effects at several anatomic sites.

Even for the colorectum, however, it is probably premature to now begin to use these drugs widely for cancer prevention. To reach that point, a weighing of the risks and benefits of the drugs needs to be made, together with a judgement regarding the benefits of alternative means of prevention. For colorectal cancer, for example, aspirin may provide only limited benefit over regular colonoscopy [95, 96]. Nonetheless, with the increased understanding of the clinical effects of NSAIDs on cancer, the development of effective chemoprevention with these drugs appears to be a real possibility.   PMID: 12795046

• Chemoprevention for pancreatic cancer.  Wolff RA.  Int J Gastrointest Cancer. 2003;33(1):27-41.
  
  For a number of solid tumors, including pancreatic cancer, efforts aimed at disease prevention may be more successful than currently available anticancer treatments.  While specific interventions are emerging to prevent breast, prostate, lung, and colorectal cancer, no trials of chemoprevention are being conducted in pancreatic cancer. Importantly, there are significant obstacles to the conduct of such research.

However, preclinical and epidemiologic studies suggest that several drugs may have chemopreventive potential in pancreatic cancer. These include aspirin and other non-steroidal antiinflammatory drugs (NSAIDs), selective cyclooxygenase inhibitors, somatostatin analogs, selective estrogen receptor modulators (SERMs), and anti-androgenic agents. As the oncology community evaluates some of these agents in large chemoprevention trials for breast, colon, and prostate cancer, it may be found that pancreatic cancer prevention occurs as an unintended, but desirable consequence. Moreover, other general societal trends, such as smoking cessation and the widespread use of cholesterol-lowering agents and aspirin, could have a role in reducing the risk of pancreatic cancer, and in the future, may lead to a decrease in its incidence.

PMID: 12909736

6:17:55 PM    

D. H. Lawrence. "Be still when you have nothing to say; when genuine passion moves you, say what you've got to say, and say it hot." [Motivational Quotes of the Day]
6:00:58 PM    

Arts Journal: Daily Arts News
5:47:45 PM    

Kim's Place

Blue Sky on Mars

The Snakepit of Bweezy's Mind

gfdc- ceci n'est pas un weblog

The Joy of Soup

5:45:20 PM    

Corridor.

My Halls of Residence were knocked down the very summer we moved out in 1999.  There are some lovely new University digs there now.  They cost a pretty penny too I imagine.  After a night out, here is a woobly photo of my floor corridor.  I was on the 7th floor.

Glasgow, Spring 1999.

5:40:48 PM    

Photo Shop. Photo studios from around the world (from the latest issue of Colors Magazine) [MetaFilter]

The photos from China are amazing.  I love the way the photos are indeed from around the world.  There is an exceptionally cute wee boy from Bulgaria as well.

5:34:20 PM    

About the Tory Party...

I agree with Matthew Parris-  see what happens when you kill your mother?

Kerguelen Columns (a must read!)

1:15:05 PM    

Meanwhile, somewhere that is NOT the Middle East....

Russian miners emerge from ordeal

"Eleven of the 13 men trapped in a flooded mine in southern Russia for six days have been brought to the surface.

The 11 were found alive on Wednesday - another was confirmed dead and a 13th is still reported as missing.   Rescuers dug though more than 50 metres (164 feet) of rock to reach the survivors, who were taken up in a lift.

In a separate incident on Wednesday, a powerful explosion hit a mine in eastern Siberia, killing at least five miners.

Initial reports said methane had exploded inside the mine at the town of Partizansk where 64 people were working at a depth of 750 metres.

Nine of the 11 who emerged from the Zapadnaya coal mine in Rostov Province walked unaided, wrapped in blankets and coated in coal dust.  ...."

This is wonderful news.  There have been regular updates on the situation on the BBC.  By all accounts the job is still an extremely unsafe one in the former Soviet Republic.   There are some excellent photos available as well.  A shame it has not been more widely reported; but then adult film entertainers losing their homes is more newsworthy.

1:00:27 PM