title: Decision-making in an era of cancer prevention via aspirin: New Zealand needs updated guidelines and risk calculators.
abstract: Based on new systematic reviews of the evidence, the US Preventive Services Task Force has drafted updated guidelines on the use of low-dose aspirin for the primary prevention of both cardiovascular disease (CVD) and cancer. The Task Force generally recommends consideration of aspirin in adults aged 50-69 years with 10-year CVD risk of at least 10%, in who absolute health gain (reduction of CVD and cancer) is estimated to exceed absolute health loss (increase in bleeds). With the ongoing decline in CVD, current risk calculators for New Zealand are probably outdated, so it is difficult to be precise about what proportion of the population is in this risk category (roughly equivalent to 5-year CVD risk ≥5%). Nevertheless, we suspect that most smokers aged 50-69 years, and some non-smokers, would probably meet the new threshold for taking low-dose aspirin. The country therefore needs updated guidelines and risk calculators that are ideally informed by estimates of absolute net health gain (in quality-adjusted life-years (QALYs) per person) and cost-effectiveness. Other improvements to risk calculators include: epidemiological rigour (eg, by addressing competing mortality); providing enhanced graphical display of risk to enhance risk communication; and possibly capturing the issues of medication disutility and comparison with lifestyle changes.
authors.affiliation: Public Health, University of Otago, Wellington. Nick.Wilson@otago.ac.nz.
authors.forename: Nick
authors.initials: N
authors.lastname: Wilson
authors.forename: Vanessa
authors.initials: V
authors.lastname: Selak
authors.forename: Tony
authors.initials: T
authors.lastname: Blakely
authors.forename: William
authors.initials: W
authors.lastname: Leung
authors.forename: Philip
authors.initials: P
authors.lastname: Clarke
authors.forename: Rod
authors.initials: R
authors.lastname: Jackson
authors.forename: Josh
authors.initials: J
authors.lastname: Knight
authors.forename: Nhung
authors.initials: N
authors.lastname: Nghiem
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D000066491:Clinical Decision-Making; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D016481:Helicobacter Infections / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D008875:Middle Aged; D009520:New Zealand; D017410:Practice Guidelines as Topic; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin