Jewish World Review Jan. 10, 2003 / 7 Shevat, 5763

Can Aspirin Prevent Esophageal Cancer?

By Robert A. Wascher, M.D., F.A.C.S. | The American Cancer Society estimates that nearly 14,000 new cases of esophageal cancer will be diagnosed in the United States in 2003, the vast majority of which will occur in men. Unfortunately, nearly 13,000 Americans will die of this disease this year, as esophageal cancer generally spreads to other sites in the body before it is diagnosed. In addition to male gender, risk factors for esophageal cancer include tobacco abuse, heavy alcohol consumption (and combined tobacco use and drinking, in particular), chronic gastroesophageal reflux disease, and advancing age.

In view of the seriousness of this disease, the prevention of esophageal cancer is of great importance. In the current issue of the journal Gastroentereology is a review of research studies over the past 20 years that addressed the effects of aspirin on the incidence of esophageal cancer.

This review, using a statistical method known as meta-analysis, identified a protective effect against esophageal cancer with both continuous and intermittent use of aspirin.

The use of the aspirin-related class of drugs referred to as nonsteroidal anti-inflammatory drugs (NSAIDs) also appeared to confer protection against esophageal cancer. Intermittent use of these medications resulted in an 18% reduction in esophageal cancer risk, while regular or frequent intake of aspirin or NSAIDs reduced the risk of esophagus cancer by 46%, An important observation was that aspirin and NSAIDs appeared to protect against the development of both of the predominant types of esophageal cancer (squamous cell carcinoma and adenocarcinoma). The protective effects of these drugs were, in turn, proportional to the frequency of their use.

This intriguing study offers encouraging evidence of an effective means of preventing a very dismal disease. Of course, abstaining from tobacco and excessive alcohol intake are important preventive measures as well. One bit of caution here: check with your doctor before adding aspirin or NSAIDs to your daily medication intake, as these drugs are all associated with an increased risk of gastrointestinal bleeding and kidney disease.


By now, almost everyone knows that Americans face a virtual epidemic of obesity. Most of us also know that this condition is associated with an increase in the risk of high blood pressure, cardiovascular disease, diabetes, and premature death. A new study in the current issue of the Journal of the American Medical Association looks at the association between various levels of obesity and lifespan. The study's authors used government databases to correlate age at death with a measure of obesity known as body mass index (BMI). The authors then compared average age at death for various degrees of obesity.

The study identified significant differences in obesity-related premature death across both gender and ethnic lines. Interestingly, younger obese adults appeared to experience a greater shortening of their overall lifespans than people who developed obesity later in life.

White males between the ages of 20 and 30 experienced a lifespan reduction of 13 years if they were in the severe obesity BMI range, while young Caucasian women with severe obesity experienced an average loss of 8 years. Based upon these findings, severe obesity may result in the loss of more than 20% of predicted lifespan for white males.

Among black men and black women older than 60, moderate obesity was not associated with a significant decrease in lifespan. However, severe obesity in younger African Americans was associated with an average lifespan reduction of 20 years for men and 5 years for women.

In summary, this study suggests that obesity, particularly during young adulthood, is associated with a significant decrease in lifespan, especially for males. Based upon this study, it is perhaps even more important that younger adults, as opposed to middle-agers, adhere to that most common of New Year's resolutions. Indeed, this study strongly suggests that the presence of severe obesity during early adulthood poses a greater threat of eventual obesity-related mortality than does the onset of obesity much later in life.

In a related study, published in the current issue of the Annals of Internal Medicine, life expectancy rates for overweight and obese participants in a large long-term study of heart disease trends were evaluated. Approximately 3,500 participants in the renowned Framingham Heart study were assessed between 1948 and 1990 in this study.

Overweight men and women who were 40 years old at the onset of the study lost an average of about 3 years of lifespan when compared to men and women of normal weight. Men who were frankly obese at age 40 lost almost 6 years of lifespan, while women who were obese at age 40 lost about 7 years of lifespan. Obese men and women who also smoked fared even worse. When compared to the statistical impact of smoking on lifespan, significant obesity during early adulthood was found to cause comparable reductions in lifespan as did tobacco abuse.

Both of these studies indicate that significant obesity during early adulthood substantially increases the risk of premature death later in life. Eat less, exercise more... live longer.


The incidence of breast cancer increased approximately 0.5% per year between 1987 and 1998. The cause-or causes-for this sustained increase in breast cancer cases has been the subject of a great deal of debate. In the current issue of the Journal of Clinical Oncology is a report that sheds additional light on this worrisome trend.

The authors used the National Cancer Institute's annual cancer statistical summary to study breast cancer trends between 1992 and 1998. They specifically looked at the differences in breast cancer estrogen receptor (ER) and progesterone receptor (PR) status. The expression of these sex hormone receptors on breast cancer cells is associated with a generally more favorable prognosis than breast cancers which lack these receptors.

The ER and PR status of breast cancer tumors may also say something about the mechanisms involved in breast cancer development, as different cancer development pathways may be involved for tumors as a function of their hormone receptor status. The study determined that the percentage of breast cancers containing ER and/or PR increased during the study period. At the same time, the overall incidence of breast cancers that did not express ER and PR remained steady. The authors, therefore, conclude that the increase in breast cancer incidence during the study period arose primarily due to an increase in tumors that were positive for ER and/or PR.

As hormonal factors are thought to play a relatively greater role in ER-positive and PR-positive breast cancers, this study provides some evidence for a hormonal basis, at least in part, for the sustained increase in the incidence of breast cancer in the United States.


Moderate alcohol intake has been shown to reduce the risk of cardiovascular disease and stroke, while heavy drinking is associated with an increased risk of liver disease, cancer and dementia. A study in this week's New England Journal of Medicine looked at the association between alcohol intake and the risk of cardiovascular disease.

More than 38,000 male health professionals participated in this study for an average off 12 years, and all study participants were free of cardiovascular disease and cancer at the beginning of the study. Their consumption of beer, red wine, white wine and liquor was individually evaluated, and the incidence of heart attacks in this population was assessed.

Men who consumed alcohol 3-4 days per week experienced a 32% decrease in their risk of heart attack when compared to men who drank alcohol less than once per week. Consumption of alcohol 4-5 times per week translated into a 36% reduction in the risk of heart attack, and alcohol consumption with meals was equally effective as alcohol consumed without food. This benefit held up for all of the alcoholic beverages studied.

This study offers strong evidence linking moderate alcohol intake with protection against cardiovascular disease, at least in males. Remember, of course, to drink alcohol responsibly.

JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at the John Wayne Cancer Institute in Santa Monica, CA. Comment by clicking here.


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12/20/02: Citrus Pectin & Cancer; Echinacea & the Common Cold; Update on High Blood Pressure Treatment

12/06/02: Calcium Intake & Prostate Cancer Risk; Alcohol Consumption & Risk of Breast Cancer; Reducing Blood Transfusions in Critically Ill Patients

12/06/02: Alcohol, Tamoxifen & Carotid Artery Wall Thickness; Coffee & Gallstones?; Irritable Bowel Syndrome Update; Statins: More Good News

11/22/02:Alcohol, HRT & the risk of breast cancer; hormone replacement therapy: more bad news; new vaccines may eliminate cervical cancer; more

11/15/02: The Effects of Diet & Exercise on Blood Pressure & Health; Growth Hormone & Sex Steroid Supplements & the Elderly; C-Reactive Protein & Cardiovascular Disease Risk

11/08/02: More Good News About Statin Drugs; Hormone replacement Therapy (HRT) & Alzheimer's Disease; A Role for Antibiotics in the Treatment of Vascular Disease?; more

11/01/02: Digoxin & gender; driving & degenerative disc disease; Coenzyme Q10 & Parkinson's Disease; Ginseng & erections; Viagra & stroke

10/25/02: Aspirin & coronary artery bypass surgery; glucosamine sulfate & progression of knee arthritis; hospital nurse staffing & patient mortality

10/18/02: Motor Vehicle Exhaust Pollution & Mortality; CT Scans, C-Reactive Protein & Heart Disease; Antiperspirant Use & the Risk of Breast Cancer; Atomic Bomb Radiation Exposure Update; more

10/04/02: Antioxidants & the Risk of Stomach Cancer; Best Way to Diagnose Appendicitis?; Coronary Artery Disease: Stent or Surgery?

09/27/02: Breast Feeding & the Risk of Asthma; HMOs & Quality of Care Scores; Red Wine & Vascular Disease

09/20/02: Dietary Folate & the Risk of Colorectal Cancer; Risks Associated with Smoking after Heart Attacks; BRCA1 Gene Mutation & the Risk of Breast & Non-breast Cancers; Breast Tissue Density & Inheritance

09/13/02: Dairy Products, Calcium, Vitamin D & the Risk of Breast Cancer; Efficacy of Nonprescription Smoking Cessation Aids; A Nutty Approach to Heart Disease Prevention; Update on Prostate Cancer

09/06/02: C-Reactive Protein & Estrogen Replacement Therapy; Walking Women & Cardiovascular Disease; Physical Activity Among Teenaged Girls

08/30/02: Babbling babies & brain function; homocysteine levels, vitamins & coronary artery disease; St. John's Wort & chemotherapy

08/16/02: A New Weapon Against Anthrax?; cataracts & motor vehicle accidents; gingko biloba takes a hit; air pollution & heart function during exercise; breast cancer genes & the estimated risk of breast cancer

08/09/02: Botulinum Toxin & Post-Stroke Spasticity; Intestinal Hormone Kills Appetite; Bone Marrow Cells Improve Blood Flow in Vascular Disease; Effectiveness of Restraining Orders on Domestic Violence

08/02/02: Mammography Saves Lives!; Obesity & the Risk of Heart Failure; High Sugar Diets & the Risk of Colon Cancer; Abuse During Childhood & Possible Effects of Genes on Antisocial Behaviors

07/26/02: Cancer: Nature vs. Nurture; Cardiorespiratory Fitness & Inflammation; Kidney Transplants from Cadaver Donors; Aircraft Cabin Air Recirculation & the Common Cold

07/19/02: PCBs & the Gender of Babies; Breastfeeding & the Risk of Breast Cancer; More Bad News About Hormone replacement Therapy

07/12/02: A cancer surgeon's perspective on hormone replacement therapy

07/08/02: Hormone replacement therapy & the risk of disease; more good news about statins; antioxidant vitamins & disease prevention; more

06/28/02: Antioxidants & the Risk of Alzheimer's Disease; Effects of Exercise on the Hearts of Patients with Mild Hypertension; Statins reduce cardiac events following angioplasty; more

06/21/02: Sex & violence and Advertising: Do Advertisers Get What they Pay For?; Don't Drink the Water (or the Salsa Either!); Vasectomy & Prostate Cancer Risk; Update on Smoking & Disease

06/14/02: Young Men, Obesity & Heart Disease; Breastfeeding & Obesity; Irritable Bowel Syndrome & rectal pain threshold; more data on cox-2 inhibitors & cancer; more

06/07/02: New coronary artery stent reduces risk of restenosis; possible cause of Parkinson's Disease identified; more

05/31/02: New biological insights into obesity & weight loss; broccoli kills cancer-causing stomach bug; anti-inflammatory drugs and the risk of heart attack

05/24/02: Molecular detection of tumor cells in the blood & prognosis; Cox-2 & breast/lung cancers; BRCA2 gene mutations & the risk of breast cancer; breast density & the risk of breast cancer

05/19/02: Moderate alcohol intake and blood sugar levels; more good news for tea drinkers; blood potassium levels & the risk of cardiovascular disease; ethnic differences in diabetic complications

05/10/02: Tea drinkers and the risk of death following heart attack; duration of breastfeeding & adult intelligence; abdominal aortic aneurysms: surgery or observation?

05/03/02: Risk of adverse drug reactions from newly released medications; preoperative beta-blockers may reduce heart bypass deaths; shape-shifting plastics may alter surgical practice; weight loss supplement may cause liver damage
04/26/02: Angry young men & risk of premature cardiovascular disease; stay-at-home dads & risk of cardiovascular disease; more on the effects of statins; dairy consumption and the risk of pre-diabetes; smallpox vaccine: good to the last drop?
04/19/02: Change your sex by drinking water?; Anti-inflammatory RXs may reduce growth of breast cancer cells; radiation treatment reduces repeat narrowing of bypass grafts
04/05/02: Fish & Omega-3 fatty acid consumption and cardiac health; news briefs
04/05/02: Can coffee reduce your risk of tooth decay?; exercise & blood pressure; a single high-fat meal reduces coronary artery function
04/01/02: Pre-diabetes: a newly defined category of health risk; teen television viewing and subsequent aggressive behavior; the benefits of strength training in the elderly; more ...
03/22/02: Bacteria, antibiotics & heart disease; mammograms: the debate continues; calcium & the risk of colon cancer ... and more
03/15/02: Mammography debate continues; statins & fracture risk; physical fitness & the risk of death; other intriguing findings
03/08/02: Blows to the chest & sudden cardiac death; air quality & the risk of lung cancer; tomatoes and your prostate
03/01/02: Diet & the risk of ovarian cancer; lifetime risk of developing high blood pressure; Osteoporosis prevention with a once-a-year injection?
02/26/02: The continuing controversy regarding screening mammography
02/22/02: Lowering body temperature after heart attack improves outcome; A silver lining for the chronically sleep-deprived?
02/15/02: Hormone replacement therapy & the risk of breast cancer; use it or lose it: Alzheimer's disease & cognitive stimulation; stress, divorce & death; child daycare, infections & parental guilt
02/08/02: Possible breakthrough in early cancer diagnosis; mammography: the controversy continues; CPR techniques revisited
02/01/02: Antibiotics in livestock feed & human disease; genetic detection of early colon cancer in the stool; genetic analysis of breast cancers may help decide treatment
01/25/02: Drug increases lifespan (if you're a fly...); workplace attitudes and smoking cessation; effects of inadequate sleep on surgeons
01/18/02: Lifelong effects of premature birth; smokers under the knife; aspirin and cardiovascular health
01/11/02: Estrogen levels in the blood & breast cancer risk; Heart attack: sex and survival; dangerous lettuce invaders
01/09/02: Cancer & aging: Two sides of the same coin?
01/04/02: Vitamin a & the risk of hip fracture in postmenopausal women; ovarian cancer risk and oral contraceptives
12/28/01: Magnetic Resonance Imaging (MRI) detects coronary artery disease; new development in obesity research; adverse childhood experiences & the risk of suicide attempts
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12/07/01: Update on school shootings; new implantable heart-assist device approved for further evaluation; prevention of fungal infections in pre-term babies
11/30/01: Flu vaccination in asthmatics; low-tar cigarettes are not less harmful; beans and your heart
11/21/01: Modified smallpox vaccine may reduce risk of cervical cancer; New approach to breast cancer diagnosis; New non-invasive prenatal diagnostic test for down's syndrome
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11/09/01: Bio-warfare (redux); my gray matter is bigger than yours; mad elk disease?
11/02/01: Making sense of bio-warfare
10/26/01: The impact of mammography on deaths due to breast cancer; diet & exercise may slow cancer cell growth; antidepressants and the risk of heart disease
10/19/01: New insights into autism; the wiley appendix
10/12/01: More bad news about obesity links to other diseases…Hey dad, can I borrow the car keys?
10/05/01: California leads nation in reduction of tobacco-related disease; exercise as an antidepressant?
09/25/01: Advances in the detection of breast cancer; primary care physician awareness of peripheral arterial disease; arsenic in the water
09/17/01: In perspective
09/12/01: Genes may hold secret to long life; men and women: cognitive function in the elderly; physical activity, obesity and the risk of pancreatic cancer
09/05/01: English milk cows prefer Beethoven and Simon & Garfunkel over Bananarama; new prostate cancer prevention study: looking for a few good men; exercise & diet can help prevent diabetes
08/28/01: Arthritis drugs may be linked with increased risk of heart disease; errors in blood clotting tests can be fatal; infant soy formula not associated with reproductive side effects

© 2002, Dr. Robert A. Wascher