Two Boston Docs Want to Study Aspirin As a Treatment for Breast Cancer
The story begins like this: “We believe that it might be possible to treat breast cancer — the leading cause of female cancer death — with a drug that can already be found in nearly every medicine cabinet in the world: Aspirin.”
Michelle Holmes and Wendy Chen are physicians and faculty members at Harvard Medical School. The two women published a co-authored piece in the New York Times on Monday, in which they outline, in shocking detail, their repeated (and rejected) attempts to seek funding.
Could it really be possible that a miracle treatment has been in our medicine cabinets this whole time?
In 2010, Holmes and Chen published an observational study in The Journal of Clinical Oncology that showed women with breast cancer who took aspirin at least once a week for various reasons were 50 percent less likely to die of the disease. In 2012, British researchers found (by combining results from clinical trials that looked at using aspirin to prevent heart disease) that aspirin was also associated with a significantly lower risk of breast cancer death.
Chen and Holmes say that there’s been no randomized trials (which is the gold standard of research) of aspirin use among women with breast cancer.
Clinical trials are typically conducted on drugs developed by labs seeking huge profits. No one stands to make money off aspirin, which has been a generic drug since the Treaty of Versailles in 1919, and which costs less than $6 for a year’s supply.
Thankfully, the first randomized clinical trial is now going on in Britain, made possible by funding from a nonprofit group, Cancer Research UK. But the British study is looking at four cancers, and won’t be done until 2025. If we in the United States had funding to do a similar trial, we could combine our data and get answers much faster. If the United States is to maintain its role as the global leader in biomedical research, it must fund its own trial of aspirin in breast cancer.
Holmes and Chen estimate that if aspirin really works, then 10,000 lives per year would be saved in the U.S., on top of an additional 75,000 saved lives in the developing world.
But why aspirin? Holmes and Chen say that aspirin has been used as a painkiller since the time of Hippocrates when the drug was derived from willow bark. “We don’t know exactly why it appears to work in fighting cancer,” they write. “Aspirin reduces inflammation, and that may play a role in inhibiting the growth of tumors — perhaps by slowing the development of new blood vessels that nourish them, or by fighting old cells that keep growing when they should be dying off. It may also inhibit estrogen production, and we know that estrogen fuels the growth of most (but not all) breast cancers.”
Aspirin is also cheap, which means that it could be used to treat people with breast cancer in poor, developing nations. But the cost to study it, however, is a different story. The doctors write:
A randomized study of approximately 3,000 women with Stage 2 and 3 breast cancer, lasting five years, would cost around $10 million. (We wouldn’t study women with Stage 1 disease because they have such a high survival rate already, nor women with Stage 4 cancer, because there is not enough evidence that aspirin would help when the disease has advanced that far.) Although $10 million is a relatively small amount for a large pharmaceutical company, it is too big for most federal grant mechanisms and nonprofit foundations.
Yet even as government funding for research is slashed, the government is still willing to test new cancer drugs pushed by pharmaceutical companies, despite very high failure rates for those drugs. Federal grant review panels have no direct financial interest in the studies they approve for funding, but inevitably they are seduced by the more novel treatments — the scientific equivalent of the latest smartphone. And generic drugs, particularly ones as old and familiar as aspirin, just aren’t sexy.
Could a simple, inexpensive, and widely used drug actually be the next great treatment for breast cancer? We’re obviously a long way off from knowing. But now is time to start the discussion, and put pressure on these big-money pharmaceutical companies to do the right thing and put together the funding so that Holmes and Chen conduct this very important randomized study.