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Comment by bell-cot | Hacker News Reader

> The team at the University of Cambridge said it was an exciting and surprise discovery that could eventually lead to cancer patients being prescribed the drug - but not yet and people are advised against just taking the pills themselves.

While the Ethics Panel and solicitors may have ordered the researchers to say that, I'm thinking that anyone with serious cancer should (1) start taking aspirin, (2) read a bit about aspirin side-effects and contra-indications, then (3) let their doctor know that they did (1) and (2).

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There are risks to taking aspirin everyday, including an increased risk of hemorrhagic (bleeding) stroke, so it's important to weigh the pros and cons. That is difficult before sufficient research has been done to identify who benefits and how much, but it's certainly something to consider.

OK, but...

I am not a doctor. I don't even play one on TV. But if I understand correctly, there are two types of strokes: hemorrhagic strokes (strokes caused by bleeding in the brain) and... I don't know the technical term, but clot-based strokes (a blood clot blocks an artery in the brain). And if I understand correctly, clot-based strokes are something like 80% of strokes - they're four times as likely as hemorrhagic strokes.

So isn't aspirin a net win anyway? You may increase your odds of a hemorrhagic stroke, but decrease your odds of the other kind of stroke, and the other kind is more common. (Unless you have some reason to think that you are more susceptible to hemorrhagic strokes than the other kind.)

Corrections welcome, especially ones with data.

Note well: This is not medical advice. Consult a doctor, not randos on the internet.

I'm not a doctor either, just a postgrad pre-med student with a heart problem (so I read a lot about the heart). I know just enough to be dangerous, but I do know you're right about the two types of stroke and the benefit of aspirin in preventing ischemic strokes (clots).

And until recently, daily aspirin was recommended for that, even for people with no history of heart disease. But AIUI, now the American Heart Association (2019) [1], U.S. Preventive Service Task Force (2022) [2], and the European Society of Cardiology (2019) [3] all say that for people with no history of cardiovascular disease, daily aspirin has little to no net benefit in younger patients and increases mortality in older patients.

Of course, the possibility of preventing metastasis adds another benefit, and may tip the balance back in favor of aspirin therapy.

1: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000678

2: https://www.acc.org/latest-in-cardiology/articles/2022/04/27...

3: https://www.escardio.org/static-file/Escardio/Guidelines/Pub...

Is there any data about the cancer incidence in people who had to take aspirin daily for those reasons ?

To be precise, this article isn't talking about aspirin preventing cancer, just stopping it from metastasizing. It links to data about that:

https://pubmed.ncbi.nlm.nih.gov/22440947/

You are assuming the pre-intervention incidence of each type of stroke is a guide to the effect size of the intervention on each, which isn't, as a rule, a justified assumption.

The main risk from aspirin isn't hemorrhagic strokes, it's GI bleeds. There are other blood thinners that are considered safer at an appropriate dose, including warfarin (the same stuff that, at higher doses, is used as rat poison). Getting dose right with this stuff is very important and varies from individual to individual. Not something that's ethical to mess with at "shotgunning the population" level (or even as a DIY thing), IMO.. there's a reason they put iodine and folate in bread, but not this stuff.

Warfarin has (mostly) been replaced by newer thinners like Dabigatran, Rivaroxaban, and Apixaban, which are much less dose dependent. Generally thinners are only given to people who have a moderate/severe risk of stroke or heart disease.

All the thinners don't just depend on dose but also on (e.g.) the amount of Vitamin K from leafy greens.

If we survive the next century (looking unlikely...) it's a fair bet that mixing AI analysis with live biochemical tracking and as-required synthesis would be the next Big Thing. Current medications are extremely crude and have hit-and-miss outcomes because the combination of diet, genetics, gender, activity levels, age, and stress (etc) all have huge effects on individual biochemistry.

Note my prior "... anyone with serious cancer should (1) ..." disclaimer.

If the cancer that you already have is (say) 10% likely to kill you, then waiting several years - for researchers to nail down details - is likely far riskier than taking aspirin now.

(No, you can't be an idiot about it. Aspirin at 50g/kg would kill you faster than any cancer could, etc., etc.)

>(No, you can't be an idiot about it. Aspirin at 50g/kg would kill you faster than any cancer could, etc., etc.)

If someone is dumb enough to down 9 lbs of Aspirin, it's on them.

If you're already on cancer, I'm wondering if you're already on other medical interventions, and now I'm wondering how aspirin will interact with those.

Humans have been trying to figure cancer out for a very long time now. If it was as simple as take more aspirin, get better odds of survival, we would've found that out a long time ago. Unfortunately, medicine is not that straightforward, no matter what a catchy article would lead you to believe.

> While the Ethics Panel and solicitors may have ordered the researchers to say that

Is there any evidence that the researchers believe otherwise? Often, people on HN accuse researchers and news of overstating results.

> I'm thinking that anyone with serious cancer should

Why should anyone trust you with treatment for "serious cancer"? Does your advice depend on what kind of cancer? The location in the body? Other factors in the patient's health?

> Why should anyone trust you with treatment for "serious cancer"?

When you're facing a death sentence, something that "works in mice" is preferable to nothing at all.

GP didn't ask that cancer sufferers avoid existing treatment; I read it more as "Aspirin cannot possibly hurt, so you may as well".

It's like buying a lottery ticket - the negative impact of doing so is negligible but the positive impact of winning is life-changing.

Same with aspirin for cancer - the negative impact of doing so is non-existent, but the positive impact is life-changing.

More life-and-death advice from an Internet rando. I think I'll ask my doctor, who has examined me, has seen thousands of cancer patients, studied the human body, health, and cancer for decades, talks to other such experts (rather than fielding ideas on HN), ...

> nothing at all

Who said anything about that?

I did it for a few weeks but I started having nosebleeds daily so I stopped.

As I recall, there are some studies that show that a daily baby aspirin can be helpful for general heart health. I you were taking an adult aspirin, that may have been the issue.

It's the teenage asprin that you really have to watch out for. It just doesn't know when to stop!

A few years ago my grandma had cancer and was told by the hospital doctor to take daily baby dosage aspirin.

I think it's safe to say if it's recommended for cancerous old folks, it's safe to take for average people.

It's just a matter of dosage.

> I think it's safe to say if it's recommended for cancerous old folks, it's safe to take for average people.

I'm not sure why you would think that. There are many things we are willing to prescribe to older people because they are unlikely to suffer long-term negative effects.

I've heard this, but it doesn't seem to pan out.

Random example: https://pubmed.ncbi.nlm.nih.gov/10381905/ - Even 10mg/day causes gastric injury/toxicity by removing the nice slime layer in your gut.

Also, once you get specific about which CVD metrics you're trying to optimize, you'll find vastly superior interventions to try.

I took half a dose daily, but went down to a quarter but that still gave me nosebleeds.

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