A new study from the US finds that use of aspirin is tied to a reduced risk for hepatocellular carcinoma, the most common type of primary liver cancer, and also to a reduced risk of death from chronic liver disease.

Vikrant V. Sahasrabuddhe, from the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, and colleagues, write about their findings in the 28 November online issue of the Journal of the National Cancer Institute, JNCI.

Hepatocellular carcinoma occurs mainly in people with chronic liver disease. Some studies suggest the cancer could be a result of the chronic inflammation in liver disease affecting cellular processes.

Because of their anti-inflammatory properties, and their widespread use to prevent heart problems and cerebrovascular diseases like stroke, researchers are investigating the potential of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) as cancer preventers.

However, a recent study published in JNCI in August, suggests while the evidence is encouraging, the cancer-protective effect of NSAIDs is not as large as previously thought, and not enough to outweigh the risks (primarily of serious bleeding in the gut), and concludes it is too early to recommend people start taking them to ward off cancer.

In the meantime, although more studies are looking at the potential anti-cancer effect of NSAIDs, the link to risk for liver cancer and death from chronic liver disease remains unclear, say the authors of this new JNCI paper, where they describe how they carried out an observational study of 300,504 men and women aged 50 to 71 years.

The participants, who were enrolled in the National Institutes of Health-AARP Diet and Health Study, had reported their use of aspirin and other NSAIDs and were followed for 10 to 12 years.

The researchers were able to link the NSAID use data from these participants to registered diagnoses of 250 cases of hepatocellular carcinoma and 428 cases of chronic liver disease.

When they analyzed the links they found participants who used NSAIDs had a lower risk of hepatocellular carcinoma and a reduced risk of death from chronic liver disease compared to participants who did not use the drugs.

But when the researchers differentiated between aspirin and non-aspirin NSAIDs, there were some marked differences.

Participants who used aspirin showed a 41% reduced risk for hepatocellular carcinoma and a 45% reduced risk of death from chronic liver disease.

Whereas participants who used non-aspirin NSAIDs showed no reduced risk for for hepatocellular carcinoma, and a 26% reduced risk of death from chronic liver disease.

Sahasrabuddhe and colleagues write:

Aspirin, in particular, when used exclusively or with other non-aspirin NSAIDs showed a consistent protective effect related to both HCC [hepatocellular carcinoma] incidence and CLD [chronic liver disease] mortality, regardless of the frequency or exclusivity of use.”

If confirmed, these associations with the use of aspirin “might open new vistas for chemoprevention of HCC and CLD,” they conclude.

In an accompanying editorial, researchers from the Department of Epidemiology and Community Medicine at the University of Ottawa in Canada, note that the known causes of chronic liver disease and primary liver cancer are use of alcohol, and hepatitis B and C virus infections, and there have also been suggestions of a link with diabetes and obesity.

We already have cheap, readily available interventions,” they write, citing examples such as vaccines for hepatitis B and C virus, although “effective strategies for reduction of HBV and HCV are not always available or fully applied.”

“Also, alcohol abuse and obesity are complex and multifactorial challenges that require interventions at the individual and system levels,” they add, concluding that while we should continue to explore the potential for new drug strategies like NSAIDs, we should not lose sight of the need to improve established practices and interventions.

Written by Catharine Paddock PhD