Cancer Therapy AdvisorDaily Low-Dose Aspirin May Decrease Cancer Risk for Some Adults, Study Suggests

Secondary analysis of the ASPREE trial reveals that clonal hematopoiesis of indeterminate potential (CHIP) at variant allele frequency ≥10% is the strongest predictor of aspirin’s cancer prevention benefit in older adults. A validated effect score model demonstrated wide heterogeneity in treatment response, with predicted individualized effects ranging from -23.0% to 21.5% cancer risk reduction. Among 9,350 participants (median age 73.7 years), the model identified distinct treatment-favorable and treatment-unfavorable subgroups based on CHIP status, smoking, age, and metabolic factors.

⚕️ Key Clinical Considerations ⚕️

• CHIP emerges as the primary beneficial predictor, with VAF ≥10% identifying patients most likely to benefit from aspirin chemoprevention, while current smoking status was the strongest predictor of detrimental effects on cancer incidence.
• Treatment-favorable subgroup (HR 0.85, 95% CI 0.71-1.00) included older patients with higher hemoglobin, family cancer history, and CHIP presence, showing actual cancer risk reduction with daily aspirin therapy.
• Treatment-unfavorable subgroup (HR 1.14, 95% CI 0.95-1.38) included current smokers and patients with higher BMI, diabetes, polypharmacy, or personal cancer history, showing potential harm from aspirin.
• Effect score model demonstrated 2.3% median improvement in 5-year absolute cancer risk reduction compared to treat-all approaches, suggesting precision medicine strategies could optimize patient selection for aspirin chemoprevention.
• Original ASPREE trial showed null results at the population level (100 mg daily aspirin vs placebo), highlighting the importance of biomarker-driven patient stratification rather than universal aspirin recommendations for cancer prevention.

🎯 Clinical Practice Impact 🎯

• Patient Communication: Discuss that aspirin for cancer prevention is not one-size-fits-all; patients with CHIP mutations may benefit while current smokers may experience increased cancer risk, requiring individualized risk-benefit discussions rather than blanket recommendations.
• Risk Stratification: Consider CHIP testing (VAF ≥10%) in older adults being evaluated for aspirin chemoprevention, particularly those with family history of cancer; advise smoking cessation as priority before considering aspirin for any indication given the strong negative prediction.
• Implementation Barriers: CHIP testing is not yet widely available or standardized in primary care settings; clinical application awaits validation in prospective trials and cost-effectiveness analyses before routine implementation in cancer prevention strategies.
• Counseling Approach: Address that patients with diabetes, obesity, polypharmacy, or personal cancer history showed less favorable responses; emphasize lifestyle modifications and evidence-based screening rather than relying on aspirin chemoprevention in these populations.

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