Cancer history and risk factors in healthy older people enrolling in the ASPREE clinical trial
Suzanne G Orchard, Jessica E Lockery, Peter Gibbs, Galina Polekhina, Rory Wolfe, John Zalcberg, Andrew Haydon, John J McNeil, Mark R Nelson, Christopher M Reid, Brenda Kirpach, Anne M Murray, Robyn L Woods, ASPREE Investigator Group, Suzanne G Orchard, Jessica E Lockery, Peter Gibbs, Galina Polekhina, Rory Wolfe, John Zalcberg, Andrew Haydon, John J McNeil, Mark R Nelson, Christopher M Reid, Brenda Kirpach, Anne M Murray, Robyn L Woods, ASPREE Investigator Group
Abstract
Background: Cancer is a leading cause of death globally. Given the elevated risk of cancer with age and an ageing population, it is important to understand the changing burden of cancer in older populations. The ASPirin in Reducing Events in the Elderly (ASPREE) study randomised healthy older individuals to 100 mg aspirin or placebo, with clinical outcomes and disability-free survival endpoints. Detailed baseline data provides a rare opportunity to explore cancer burden in a uniquely healthy older population.
Methods: At study enrolment (2010-2014), self-reported personal cancer history, cancer type and cancer risk factor data were sought from 19,114 participants (Australia, n = 16,703; U.S., n = 2411). Eligible participants were healthy, free of major diseases and expected to survive 5 years.
Results: Nearly 20% of enrolling ASPREE participants reported a prior cancer diagnosis; 18% of women and 22% of men, with women diagnosed younger (16% vs 6% of diagnoses <50 years). Cancer prevalence increased with age. Prevalence of prostate and breast cancer history were higher in U.S. participants; melanoma and colorectal cancer were higher in Australian participants. Cancer history prevalence was not associated with contemporary common risk factors nor previous aspirin use, but was associated with poor health ratings in men. Blood and breast cancer history were more common with past aspirin use.
Conclusions: Personal cancer history in healthy older ASPREE participants was as expected for the most common cancer types in the respective populations, but was not necessarily aligned with known risk factors. We attribute this to survivor bias, likely driven by entry criteria.
Trial registration: International Standard Randomised Controlled Trial Number Register (ISRCTN83772183) and clinicaltrials.gov (NCT01038583).
Keywords: Aspirin; Cancer epidemiology; Cancer prevalence; Cancer risk factors; Selection criteria; Survivor bias.
Conflict of interest statement
Declaration of Competing Interest The ASPREE trial was supported by a National Institute on Aging grant (U01AG029824) with supplemental funding from the National Cancer Institute at the National Institutes of Health (R01 CA137178), by grants (334047 and 1127060) from the National Health and Medical Research Council of Australia, and by Monash University and the Victorian Cancer Agency. These sponsors did not contribute to study design, data collection, analysis, data interpretation, manuscript writing or the decision to submit this article for publication, however, representatives of the NIA sit on the International Executive Committee in an advisory role. Mark Nelson received travel and financial support to attend an advisory board meeting sponsored by Bayer AG, which provided study medication for the ASPREE trial. Anne Murray and John McNeil received travel and consulting fees to present published results from the ASPREE study at a Bayer AG sponsored conference. All other authors declare that there has been no financial or personal interest that has affected their objectivity.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Source: PubMed