阿斯匹靈，癌症的風險和個人的決定

Aspirin, cancer risk and a personal decision

Fergus Walsh | 00:00 UK time, Tuesday, 7 December 2010

From now on I am going to take a daily low-dose aspirin. I intend to continue doing this for the next 25 years. It's a decision which every middle-aged person in Britain is going to have to consider in the light of research suggesting that aspirin significantly cuts the death rate from many common cancers.

從現在開始，我將每天食用低劑量阿斯匹靈。在未來25年我也打算繼續這樣做。這是在英國的每個中年人將不得不考慮的一線曙光的研究，該研究表明阿斯匹靈顯著降低許多常見的癌症死亡率。

You can read my report on the Lancet study and an abstract of the research paper.

你可以閱讀我的報告在“the Lancet study 的研究報告和研究論文摘要。

I cannot say for sure that I am doing the right thing. If I get an intestinal bleed in a few months time and am taken to hospital needing a blood transfusion, then it will be easy to argue that I got it wrong.

That sort of adverse drug incident, for which aspirin is a known risk factor, is easy to track. The absence of disease is a more subtle effect, because who can say for sure why some people get cancer and others do not?

我不能肯定地說我做的是正確的事。如果我在短短幾個月時間引起腸出血而須送往醫院輸血，那麼就很容易的認為我錯了。

這是阿斯匹靈這類藥物有那麼點不良副作用，這是一個已知的危險因素，很容易追踪。沒有疾病更是種微妙的影響，因為誰可以肯定地說，為什麼有些人會得癌症而有些人不會呢？

It is the new research showing aspirin's apparently protective effect against cancer which has persuaded me. This, I must stress, is a personal decision.

As a 49-year-old in reasonable health with no obvious signs of cardiovascular disease, I've made my own choice. I think it would be dishonest of me to write a long article about this issue and then fail to answer the obvious question - are you going to take aspirin? But I am certainly not trying to encourage anyone else to follow my example.

新的研究顯示阿斯匹靈顯然具保護性的防癌效果已說服我。但我必須強調，這是一個個人的決定。

作為一個沒有心血管疾病明顯的跡象且健康的49歲合理的理由，我做了自己的選擇。我認為我寫一個有關這個議題的長篇文章，卻無法來回答一個顯而易見的問題是不誠實的 - 你要服用阿斯匹靈嗎？但我絕對不是鼓勵別人須按照我的例子。

“The Lancet”的論文

In the Lancet paper researchers, from Oxford University, Edinburgh, Dundee, London and Japan analysed eight trials, some dating back to the 1970s, which had allocated volunteers to daily aspirin or a dummy pill. The original trials were looking at cardiovascular disease, and the data on cancer had never been fully investigated or published.

the Lancet paper 論文來自牛津大學，愛丁堡，鄧迪大學，倫敦和日本的研究人員分析了8個試驗中，有些可以追溯到20世紀70年代，志願者已被分配每天服用阿斯匹靈或一錠安慰劑。原試驗是要尋找心血管疾病相關數據，而在癌症的數據從來沒有被充分調查或公佈。

By dusting down the data and then following up many of the patients health records, the researchers came up with some remarkable results. Those allocated aspirin for between four and eight years had about a 25% lower risk of dying from cancer. This protective effect continued long after the trials had ended. Indeed, after 20 years, their overall risk dying from cancer was still 20% lower than the placebo group.

藉著開啟塵封多時的數據，然後跟進許多患者的健康記錄，研究人員追蹤出一些顯著的結果。那些分配阿斯匹靈為四年到八年之間的受試者其死於癌症的風險降低25％左右。試驗結束後，這種保護作用長期持續。事實上，20年後，他們的整體死於癌症的風險仍比安慰劑組低20％。

The research was led by Professor Peter Rothwell, a clinical neurologist at Oxford University, who two months ago published a study which found that a daily low dose of aspirin cut cases of bowel cancer by a quarter and deaths by more than a third.

這項研究是由牛津大學臨床神經科醫師彼得·羅思韋爾教授所主持，他兩個月前發表一項研究，發現每天低劑量阿斯匹靈可減少四分之一腸癌罹患率和降低超過三分之一死亡人數。

How aspirin affects cancer

阿斯匹靈如何影響癌症

The mechanism by which aspirin appears to protect the body against cancer is not clear. But Professor Rothwell said laboratory tests suggested aspirin intervenes at a very early stage to prevent cancers developing.

阿斯匹靈能顯見在保護身體對抗癌症的機制，目前尚不清楚。但Rothwell教授說，實驗顯示在一個非常早期的階段進行阿斯匹靈干預，以防止癌症的發展。

He said:"When cells divide there is a chance that the DNA in the daughter cells will be faulty. The body has an mechanism whereby either the faulty cells commit suicide (known as apoptosis) or they self-repair. Aspirin appears to enhance the suicide or the repair."

他說：“當細胞分裂時，在子細胞的DNA有機會出現故障。身體有一個機制，即要嘛有缺陷細胞自殺（被稱為細胞自毀凋亡）或自我修復。阿斯匹靈似乎會加強細胞自殺或修復。“

Conflicting research Conflict

衝突的研究

The trouble is, that there has been lots of conflicting research about the risks and benefits of taking aspirin.

We already know that aspirin can protect those at increased risk of heart attack and stroke. But for healthy adults without a history of cardiovascular disease, the benefits are very small and seem cancelled out by the increased risks of bleeding from the stomach and gut.

麻煩的是，與服用阿斯匹靈有關的風險和利益衝突的研究很多。

我們已經知道，阿斯匹靈可以保護預防增加心臟病發作和中風的風險。但對於沒有心血管疾病史的健康成人，好處是非常小的，且從胃和腸道出血的風險增加似乎被抵銷用處。

The last report I did on aspirin, in 2008 was about a study in the British Medical Journal. It looked at 1300 adults in Scotland with diabetes who had no previous symptoms of heart disease. It found that aspirin had no protective cardiovascular effect. The study authors said the research added to evidence that aspirin should not be routinely used for patients at higher of heart attack and stroke unless they already had symptoms of disease.

我最近對阿斯匹靈的研究是在2008年，該報告是英國醫學雜誌的研究。這是在蘇格蘭觀察1300患有糖尿病，且以前沒有心臟疾病症狀的成人。研究發現，阿斯匹靈沒有保護心血管作用。這項研究的作者說，這項研究證據顯示，阿斯匹靈不應該被經常使用在心臟病發作和中風風險高的病人，除非他們已經有疾病症狀。

In the past two years, many GPs have been taking healthy middle-aged patients off aspirin.

在過去的兩年中，許多家醫已停止健康的中年患者服用阿斯匹靈。

A game changer?

改變遊戲規則？

The question now is, do the findings on cancer change things? Professor Rothwell said it would be helpful if new guidance was issued in the light of the new findings. There are guidelines from the American Heart Association and the European Society of Cardiology, but these pre-date the cancer research. NICE may also decide to review the role of aspirin. The tablets themselves cost just a few pence.

現在的問題是，發現其在癌症的事實會改變事情的結果嗎？羅思韋爾教授說，如果新的指引在新的發現裡有一線曙光，這將是有益的。但這預先發表的癌症研究，有來自美國心臟協會和歐洲心臟病學會的指引。

NICE( National Institute for Health and Clinical Excellence)也可以決定重新審查阿斯匹靈的作用。該藥片本身的成本只有幾便士(一分)。

Professor Rothwell did not go so far as to urge people to take aspirin, but he said the evidence was beginning to look compelling. He said people might want to consider taking low-dose daily aspirin (75 mg) from the ages of 45-70 or 50-75. After the age of about 75 the benefits of aspirin were likely to fall away, whereas the risk of gastric bleeding rose considerably.

Rothwell教授並沒有積極敦促人們服用阿斯匹靈，但他說研究證據開始令人注目。他說，人們可能可考慮從45-70或50-75歲，每天服用低劑量（75毫克）阿斯匹靈。75歲以後，阿斯匹靈的好處則有可能消失，且胃出血的風險大大上升。

Another expert on the effects of aspirin, Professor Peter Elwood, from Cardiff University, said people should make the decision themselves as to whether to take aspirin. "It is up to the man in the street to weigh up the risks of getting cancer, having a heart attack or stroke and setting that against the risk of being rushed to hospital with internal bleeding". But he added the risks of dying from a gastric bleed were "small".

另一個研究阿斯匹靈專家加的夫大學教授彼得·埃爾伍德說，人們應該自己決定是否服用阿斯匹靈。“一般人須衡量罹患癌症，心臟病發作或中風的風險，抵銷匆促被送往醫院有內部出血的危險”。但他補充說，胃出血死亡的風險是“很小的”。

Professor Elwood, an epidemiologist, who did some of the first research into the effects of aspirin on heart attack and stroke, said doctors were good at treating disease, but when it came to preventing ill-health then people had to make their own judgements.

埃爾伍德教授，是一位流行病學家，他率先做了一些阿斯匹靈對心臟病發作和中風的效果的研究，他說，醫生用在治療疾病時很好，但是用它來防止健康則欠佳，所以人們不得不做出自己的判斷。

But that is hardly an easy decision for people to make. Very few will have time to read the latest research, let alone weigh it against other studies. At some point the medical profession will need to come to a considered view and issue guidance.

但是，人們很難以做出一個簡單決定。很少人有時間閱讀最新的研究成果，更不用說其他研究來權衡。在某些時候，醫學界需要觀點和議題指導來考慮。

Cancer Research UK suggested that anyone considering taking aspirin every day should talk first to their GP. I'm not sure that family doctors will welcome being inundated with requests for a consultation on this topic, but I suppose patients could mention it if they are at their GP for something else.

英國癌症研究中心的建議，考慮每天服用阿斯匹靈的人應該和自己的家庭醫生先談談。我不知道家庭醫生是否會歡迎被這個協商話題的請求給淹沒，但是我想病人如果他們和自己的家庭醫生討論可以提提關於它別的作用。

Professor Alastair Watson, an expert in translational medicine at the University of East Anglia, also urged people wishing to take aspirin to discuss it with their GP. Nonetheless, he added that the research was "further proof that aspirin is, by a long way, the most amazing drug in the world."

東英吉利亞大學轉化醫學專家阿拉斯泰爾·沃森教授還呼籲希望服用阿斯匹靈人們與他們的家庭醫生討論。儘管如此，他補充說，這項研究“世界上最神奇的藥物-阿斯匹靈 進一步的實證，還有很長的路要走”。

Peter Sever, Professor of Clinical Pharmacology and Therapeutics at Imperial College London, agreed that the research was exciting, but he said it was still not possible to decide whether daily aspirin use was advisable for those without cardiovascular disease.

英國倫敦帝國學院臨床藥理學與治療的Peter Sever教授，同意認為該研究是令人興奮，但他說，仍然無法決定是否建議那些沒有心血管疾病的人每天服用阿斯匹靈。

He said:"We have to remember that aspirin is not a safe drug and it causes harm. And until such time as we know what the numbers are - how many cancers are prevented against how many people suffer significant bleeding then we cannot answer that question."

他說：“我們需記住，阿斯匹靈不是一種安全的藥物且它會造成傷害。時至今日我們已知道的數據是如何-有多少癌症被抵擋，有多少人患有明顯出血，我們無法回答這個問題。“

There will be many who will label aspirin a wonder drug, but the Lancet research raises several issues. For example, we do not know what the effect of very long-term use of aspirin might be.

Professor Rothwell said: "There might be some unexpected hazard from taking aspirin over many years, still yet to be discovered".

有很多將阿斯匹靈貼上神奇藥物的標籤，但“the Lancet research”的研究提出了幾個問題。例如，我們不知道長期使用阿斯匹靈可能有什麼效果。

Rothwell教授說：“服用阿斯匹靈多年有可能會產生一些意想不到且仍未被發現的危險”。

We also don't have sufficient evidence for the effects of aspirin on the incidence of breast or ovarian cancer, but this should emerge in the next few years.

我們也沒有足夠的證據證明阿斯匹靈對乳腺癌或卵巢癌發病率的影響，但在未來的幾年應會出現。

For the record, Professors Rothwell and Elwood both take aspirin every day. Elwood has been doing this since the mid-70s, whereas Rothwell, who is 46, has been taking aspirin for two years.

Professor Elwood said taking aspirin at night, with calcium, appeared to enhance its effects. Since milk is a good source of calcium and can reduce stomach irritation, he suggested some new trials should test the effects of taking aspirin with a glass of milk.

根據有關記錄，Rothwell (羅思韋爾)和 Elwood(埃爾伍德)教授每天都服用阿斯匹靈。Elwood(埃爾伍德)已自70年代中期以來如此在做，而 Rothwell(羅思韋爾)，則是從46歲，一直服用阿斯匹靈迄今兩年。

Elwood(埃爾伍德)教授說，晚上服用阿斯匹靈與鈣，似乎可以加強其效果。由於牛奶是鈣的良好來源，可以減少對胃的刺激，他建議應該測試一些服用阿斯匹靈與牛奶這項新的試驗的影響。

Of course, it is perfectly possible that some new study will change things yet again. But for now, aspirin and a glass of milk will be part of my evening routine.

當然，這一些新的研究將再次改變的事情是完全可能的。但現在，阿斯匹靈和一杯牛奶將是我晚上例行的一部分。