"Frequent" aspirin use lowers ovarian cancer risk regardless of genetic susceptibility, finds JAMA study

It is already known that frequent use of aspirin reduces the risk of ovarian cancer. Do genetic factors modify this? The unknown fact in this association is the role of genetic factors and their modification. There needs to be a better understanding in this context because aspirin usage for ovarian cancer chemoprevention will focus on higher-risk subgroups "specifically".

Ovarian cancer, a malignant neoplasm, has modifiable risk factors. Researchers previously said that when aspirin is used daily or near daily, it protects against ovarian cancer. As depicted in the pooled analysis, frequent use of aspirin reduces the risk of ovarian cancer by 13%.

Though aspirin's role as a chemopreventive agent is "promising" for ovarian cancer, many factors, like the risk of gastric ulcer, hemorrhagic stroke, etc., limit its usage. Since the incidence of ovarian cancer is low, so number needed to treat to prevent 1 case of ovarian cancer is high. Targeting chemoprevention programs could reduce the number needed to treat, thereby improving the benefit-harm profile.

A team of researchers investigated the epidemiologic risk factors in ovarian cancer but did not observe effect modification by them. So in the present study, they tested "Whether frequent aspirin use has association with ovarian cancer is modified by genetic susceptibility to ovarian cancer, using a polygenic score (PGS) based on common genetic variants?"

The researchers were from National Cancer Institute, Rockville, Maryland and Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.

This pooled analysis of eight case-control studies from the Ovarian Cancer Association Consortium. Researchers evaluated the association between frequent use of aspirin and ovarian cancer, modified by a polygenic score (PGS) for ovarian cancer (nonmucinous).

The conclusive study points include the following:

• There were 4476 cases aged 58 years and 6659 controls aged 57 patients; there was no evidence of effect modification by the PGS.
• The Exposure was frequent aspirin use, daily or almost daily, for six months or longer.
• The outcome was nonmucinous epithelial ovarian cancer.
• The logistic regression method and likelihood ratio tests investigated effect modification by the PGS.
• Case patients and control participants (self-reported) were Black (122 and 218), White (3995 vs 5851) or of other races and ethnicity (348 vs 580).
• Race and ethnicity were unknown for 11 vs 10 participants for case and controls, respectively.
• Five hundred seventy-five cases constituting 13%, and 1030 controls constituting 15%, reported frequent aspirin use.
• The 13% reduction in risk of ovarian cancer associated with frequent aspirin use having OR, 0.87 unmodified by the PGS.
• Consistent ORs were observed among individuals having PGS less than 0.85 and greater than 0.86 median.
• There were similarities in results by histotype.

The authors from this original investigation entitled, "Association of Frequent Aspirin Use With Ovarian Cancer Risk According to Genetic Susceptibility", said, "Our findings suggest that genetic susceptibility to ovarian cancer on the basis of currently identified common genetic variants do not appear to modify the protective association existing between frequent aspirin use and risk of ovarian cancer.

Future work is required to explore the role of aspirin usage for ovarian cancer prevention among individuals at higher risk.

Further reading:

Hurwitz LM et al. Association of Frequent Aspirin Use With Ovarian Cancer Risk According to Genetic Susceptibility. JAMA Netw Open. 2023;6(2):e230666. doi:10.1001/jamanetworkopen.2023.0666