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Dear Doctors: The recommendation against taking a daily baby aspirin seems to pit heart disease prevention against bleeding risk. But it doesn’t include aspirin’s potential benefits in colon cancer reduction. How should people factor in the colon cancer benefit? Who makes these recommendations?
Dear Reader: You’re referring to new draft guidelines, introduced by members of the U.S. Preventive Services Task Force, about using low-dose aspirin to prevent heart disease and stroke. They propose that the daily regimen should no longer be routinely recommended to older adults who are not at elevated risk. The reasoning is that the potential protective cardiovascular benefits are outweighed by the bleeding risks, which increase as people grow older. These proposed changes wouldn’t apply to patients who have already had a heart attack or a stroke, or to individuals already taking low-dose aspirin under a doctor’s care. If the guidelines are approved, patients who use low-dose aspirin will be urged to check with their doctors to see if changes are merited.
In addressing the daily use of low-dose aspirin to lessen the risk of heart attack and stroke, the panel returns to a topic that has always been controversial. This is for the reason you mention in your letter. That is, the use of low-dose aspirin is basically an exercise in risk tolerance. Aspirin’s primary use is as a pain reliever. But it’s also a blood thinner, and taking it on a regular basis may lower the likelihood of developing a blood clot. However, it is also known that, even at low doses, aspirin can cause gastrointestinal bleeding. This is increasingly true as people grow older. So when someone follows a daily regimen of low-dose aspirin, they are balancing the potential cardiovascular benefits with the risk of bleeding, which can pose its own negative health consequences.
When it comes to the recommendation for older adults to use low-dose aspirin to lower the risk of colon cancer, which the panel introduced in 2016, changes are being considered there as well. This is because recent studies have raised questions about the drug’s efficacy when its use is initiated in older age. When started at a younger age, however, there does appear to be some protective benefit. So, as with low-dose aspirin for heart disease, the guidelines regarding colon cancer prevention will be based on age, medical history and health status. It’s important to note that none of these proposed changes can become final until public comments are completed in early November. Once the dust has settled on this latest round of adjustments, we’ll revisit the updated recommendations.
These proposals come from the U.S. Preventive Services Task Force. It’s a rotating panel of up to 16 physicians from a variety of disciplines. Each has expertise in analyzing scientific data. Their goal is to assess the safety and efficacy of preventive measures, including screening, medications and counseling, for use by people without symptoms of disease. Although the task force is appointed and funded by a division of the U.S. Department of Health and Human Services, its recommendations are independent. They provide context and guidance, but they are not considered official positions by the U.S. government.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.