Aspirin or not?

I take one before bed every night. It takes away my little aches and itches that get in the way of becoming one with the bed. And the long-term use of aspirin may (or may not depending on what you read) be associated with a decreased risk of cancer.

How much and how often you pop the pain reliever seems to be an important issue as to whether or not aspirin use will relieve your cancer risk as well as your pain. Itty bitty heart-disease preventing doses do not seem to help per the women of Iowa. The nurses of the Nurses Health Study, however, proved that if a little won't help, a bit more may do.

Over twenty years of follow-up, the dedicated health professional subjects of the NHS faithfully reported their aspirin use to investigators every 2 years. Those who took two or more regular strength (325 mg) aspirins per week for at least 10 years enjoyed a 33% reduced risk of colon cancer. Just last month, nearly 150,000 participants in the Cancer Prevention Study II Nutrition Cohort (dubbed a "relatively elderly population") confirmed that same 1/3 risk reduction for colon cancer with the regular use of aspirin.

So why wouldn't we all just do it, just down a daily Bayer? Consider a couple of stories from my practice before you conclude that aspirin does not cause stomach problems. Remember that each of these patients had no history of gastric distress.

Years ago, a thirty-something patient of mine called me in the middle of the night vomiting blood. She took aspirin on a regular basis for neck pain. Call an ambulance, head for the ER! Can't, said she, nothing to do with her young son, no one to care for him. The obvious solution? She got in a cab, dropped young son off at my house to spend the night until his dad could come get him, then she proceeded to the hospital where she was treated for bleeding from an aspirin-induced stomach ulcer.

Patient number 2 walked unsteadily into my office more recently, white as a sheet and dizzy after days of passing black stools (digested blood from the upper intestine emerges black out the back end). His problem? Blood loss from a gastric ulcer caused by daily use of low-dose aspirin for prevention of heart attack. No warning, no pain, just loss of half his blood volume down the toilet.

So aspirin or no? Like all the things we do for health, this one's a weighted decision.