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WOMEN with breast cancer who take aspirin at least twice a week can more than double their chance of surviving, researchers in a 30-year project say.

The original article can be found at: * http://www.adelaidenow.com.au/news/world/asprin-a-breast-cancer-lifesaver/story-e6frea8l-1225831951911

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This subject has been featured recently in many media outlets both in Australia and internationally with similarly optimistic headlines. The story is that is present in two parts. The first is a very positive summary of the research findings, the implication of compelling results from a prestigious US research institution and a very large and long study of 238 000 nurses. The second half of the story is more cautious in referring to potential adverse effects of aspirin, warning that for some people the harms will outweigh possible benefits and the need for further confirmatory research.

What is not made clear is that the findings are based on a small subset of nurses (4164), self-reports of aspirin use, no information on the doses of aspirin used and that it is an observational study (a low level of evidence) as opposed to a randomised controlled trial (highest level of evidence).

The original paper in the Journal of Clinical Oncology states some of the challenges with a study of this type noting the women who develop recurrent disease are likely to be treated with chemotherapy and told not to take aspirin - possibly biasing the study results in favour of a beneficial aspirin effects.

The authors recognise the complexity of the question they are trying to answer "women whose breast cancer worsens may increase aspirin use because of symptoms or decrease use because it interferes with treatment. However, aspirin itself may influence whether the disease worsens."

This type of study cannot provide definitive evidence to answer this question. It can only suggest a question that needs to be tested more rigorously in properly conducted randomised controlled studies.

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