A study of low-dose aspirin and cancer

If an ASPREE participant has a cancer biopsied or surgically removed, we will seek permission to collect a sample of the tumour from the pathology service for inclusion in the ACES sub-study.

If an ASPREE participant has a cancer biopsied or surgically removed, we will seek permission to collect a sample of the tumour from the pathology service for inclusion in the ACES sub-study.

There are some studies that indicate aspirin may reduce the incidence and spread of some cancers, however this has not been fully researched in older people. Before aspirin can be recommended to help prevent cancer, it needs to be proven to be safe and effective.

In 2013, the National Cancer Institute, a branch of the National Institutes of Health in the USA, provided additional funding to better understand the relationship between cancer and aspirin in healthy older people.

ACES, the ASPREE Cancer Endpoints Study, will further investigate the effect of aspirin on the development and spread (metastasis) of different types of cancer.

All ASPREE participants are invited to be in the ACES study, regardless of where they live, in the USA or Australia. Participation is completely voluntary and will not affect participation in the principal ASPREE study.

What does participation involve?

The ACES sub-study has 3 components:

  • Collecting cancer-related information During a study visit, ASPREE research staff will ask a series of questions about lifestyle factors such as smoking and drinking history, cancer screening, tests, cancer diagnoses (old and new) and family history of cancer.
  • Storing a genetic sample of blood or saliva We may ask ASPREE participants, who have not already provided a blood sample to the Healthy Ageing Biobank, for a one-time saliva (spit) sample, which can be donated during a visit or afterwards from home.
  • Storing a tumour sample If an ASPREE participant has a cancer biopsied or surgically removed during the trial, we will seek permission to collect a small sample of the tumour tissue for storage in our biorepository. Consent for ASPREE staff to contact the pathology service is only required once and can be given at a study visit.

The biorepository of blood, saliva and cancer tissue from ASPREE participants will facilitate genetic investigation into the effect of aspirin on cancer. Research using these samples may help predict the incidence of specific cancers, their spread (metastasis) and the impact of a therapy on cancer-free survival.

Frequently asked questions about aspirin, cancer and the ACES sub-study

How does aspirin affect cancer?

Cancer is a disease where cells, the building blocks of organs and tissues in our body, grow and multiply at an uncontrolled rate. These rogue cells develop their own blood supply, which in turn increases their capacity to multiply further, forming a tumour. Tumours that do not spread, such as moles, are generally benign. Malignant cancers can spread throughout the body, invading healthy tissue, reducing normal, healthy function. There are more than 100 different types of cancer.

It is not understood how aspirin may affect cancer. Possible mechanisms include:

  • aspirin may reduce inflammation which may be a precursor to some cancer development
  • aspirin may help the body expel the ‘rogue’ cancer cells which otherwise have the ability to multiply unchecked
  • aspirin may limit the development of blood vessels which are needed to support tumour growth
  • aspirin may impede the spread of cancer cells through an effect on platelets.

What does the ACES study involve?

  1. You will be provided with information about the ACES sub-study and asked for your consent to be involved.
  2. During a study visit, ASPREE staff will ask you a series of questions about lifestyle factors such as smoking and drinking history, cancer screenings, cancer diagnosis (old or new) and family history of cancer. If you haven’t already provided a sample of blood for the Healthy Ageing Biobank, you will be asked to provide a one-off saliva sample during your study visit or later at home.
  3. No further action is required. However, if at some point during your time in the trial,  you do have a cancer biopsied or surgically removed, we will seek permission to collect a sample of the tumour from the pathology service. This sample will be stored in our biorespository for further research.

In Australia, saliva and tumour samples are de-identified and stored with blood and urine samples in the ASPREE Healthy Ageing Biobank. The Healthy Ageing Biobank is a biorepository- a ‘library’ or ‘bank’ of biological specimens that form an invaluable resource for future research into diseases that affect older people.

How does saliva and blood help to study cancer?

Saliva and blood samples contain important genetic information (DNA) which helps researchers identify genetic patterns associated with cancer. A person’s blood may have additional ‘biomarkers’, such as proteins, which can provide additional information about cancer. The information gathered from the biospecimens may help researchers understand the effect of aspirin on the incidence and spread of cancer.

For example:

• Future research on the samples may reveal relationships between a particular type of cancer and the presence of a protein in the blood or perhaps anomalies in the genetic pattern. For instance, in other studies the ‘Philadelphia’ chromosome has been shown to be associated with chronic myeloid leukaemia (CML). Individuals identified as being at greater risk of CML can then be closely monitored by their health care provider.

• Research on biospecimens may provide the bridge between physical health and what is happening at a genetic or cellular level to better predict who is at an increased risk of a type of cancer. It may also help identify the best therapy to prevent or treat the disease.

What will happen to my saliva and tumour sample?

In Australia, saliva and tumour samples are de-identified and stored with blood and urine samples in the ASPREE Healthy Ageing Biobank. The Healthy Ageing Biobank is a biorepository- ‘library’ or ‘bank’ of biological specimens that form an invaluable resource for future research into diseases.

Where is the ACES study being undertaken?

All ASPREE participants in the USA and Australia are invited to be in the ACES study, regardless of where they live.

How are tumour samples collected?

After your doctor has arranged for a biopsy or surgical removal of a tumour, the tissue is sent to a pathology service to diagnose the type of cancer cells and to stage its progression. The tissue sample will be stored at the pathology service provider for many years. This process is part of a patient’s normal care and occurs outside of ASPREE.

With your consent, ASPREE ACES staff will contact the pathology provider, requesting a small sample of the cancer for long-term storage in the biorepository,
Your consent for ASPREE to contact the pathology service is only required once and can be given at a study visit.

How will ASPREE know when I’ve had a tumour removed?

Participants are able to advise ASPREE staff of any new illness during our regular phone calls, and at annual study visits.

Are there any types of cancer tumours that aren’t included in the study?

Although we collect information on the incidence of all types of cancer, samples from benign (non-malignant) tumours and basal cell and squamous cell carcinomas, are not required.

Will I have access to information about my genetic information and/or risk of cancer?

To date, there has been no analysis of any sample in the ACES study. ACES participants are helping to develop this important resource to better understand the effect of aspirin on the types of cancers affecting older people. Analyses on de-identified samples will be performed only if a project is ethically approved and funding obtained.

It is important to note that the pioneering nature of research into biospecimens, including genetic testing, means any information may take many years to identify and verify.

The type of information that MAY be available to our participants in the future will depend on the nature of the research project and whether the tests and results are applicable to ‘real life’.

However, if a known genetic mutation of clinical relevance should be identified in a sample, ethics committees overseeing the research project will govern how to proceed.

 

Collaborators:
  • Monash University
  • Berman Center for Outcomes and Clinical Research (Minnesota) plus 21 centres in the USA
  • Menzies Research Institute (TAS)
  • The University of Melbourne
  • Australian National University
  • The University of Adelaide
  • GP Co-investigators
Funding:
  • National Cancer Institute (NCI), USA
  • Monash University
  • Commonwealth Scientific and Industrial Research Organisation (CSIRO)