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Aspirin use and risk of hepatocellular carcinoma incidence and mortality in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

Principal Investigator
Name
Holli Loomans-Kropp
Degrees
Ph.D., M.P.H.
Institution
National Cancer Institute
Position Title
Cancer Prevention Fellow
Email
About this CDAS Project
Study
PLCO (Learn more about this study)
Project ID
PLCO-601
Initial CDAS Request Approval
Mar 18, 2020
Title
Aspirin use and risk of hepatocellular carcinoma incidence and mortality in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial
Summary
Incidence of and mortality from hepatocellular carcinoma (HCC) in the United States has been increasing over the last several decades (1, 2). Due to these increasing trends, uncovering mechanisms for cancer prevention is a significant public health need. The long-term use of aspirin has demonstrated efficacy in reducing overall gastrointestinal cancer risk (3, 4). Recent clinical data has linked aspirin use to reduced risk of incident HCC (5). However, the potential benefits of aspirin for HCC prevention may be influenced by the presence of comorbidities, including underlying viral hepatitis, obesity and type 2 diabetes (6). For example, among individuals with hepatitis B infection, risk of HCC showed a dose-response relationship with another cancer preventive agent, statins (7). A similar association was noted among individuals with type 2 diabetes (8). Due to the widespread use and cancer preventive potential of aspirin, further evaluating the association between aspirin use, comorbidities, and HCC risk is warranted. Therefore, in this study, we propose to examine the association of aspirin use with risk of incident HCC and HCC-related mortality in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. We will further evaluate HCC risk among individuals with and without underlying comorbidities, such as viral hepatitis, obesity and diabetes.

References
1. Kim H.-S., El-Serag H. B. (2019). The epidemiology of hepatocellular carcinoma in the USA. Current Gastroenterology Reports 21(17).
2. Beal E. W., et al. (2017). Trends in the mortality of hepatocellular carcinoma in the United States. J Gastrointest Surg 21:2033-2038.
3. Cao Y., et al. (2016). The population impact of long-term use of aspirin and risk of cancer. JAMA Oncol 2(6):762-769.
4. Loomans-Kropp H. A., et al. (2019). Association of aspirin use with mortality risk among older adult participants. JAMA Netw Open 2(12):e1916729.
5. Simon T. G., et al. (2018). Association between aspirin use and risk of hepatocellular carcinoma. JAMA Oncol 4(12):1983-1960.
6. Yang J. D., et al. (2019). A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol 16:589-604.
7. Tsan Y.-T., et al. (2012). Statins and the risk of hepatocellular carcinoma in patients with hepatitis B virus infection. J Clin Oncol 30(6):623-630.
8. Kim G., et al. (2017). Effect of statin on hepatocellular carcinoma in patients with type 2 diabetes: a nationwide nested case-control study. Inter J Cancer 140(4):798-806.
Aims

• Evaluate the association between aspirin use (yes/no and frequency of use) and incident HCC
• Investigate the association between aspirin use (yes/no, frequency of use, duration of use) and liver cancer mortality
• Among individuals with HCC, we will evaluate the association between pre-diagnostic aspirin use and HCC mortality (Sensitivity analysis)

Collaborators

Tracey Simon, Harvard Medical School/Massachusetts General Hospital
Andrew T. Chan, Harvard Medical School/Massachusetts General Hospital
Asad Umar, Division of Cancer Prevention, National Cancer Institute

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