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Malcolm A. Smith, Boris Freidlin, Lynn A. Gloeckler Ries, Richard Simon, Response: Re: Trends in Reported Incidence of Primary Malignant Brain Tumors in Children in the United States, JNCI: Journal of the National Cancer Institute, Volume 91, Issue 11, 2 June 1999, Pages 973B–974, https://doi.org/10.1093/jnci/91.11.973b
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Dr. Varner questions whether the jump in childhood brain cancer incidence in the mid-1980s may have been related to the rapid decline in the use of aspirin among children in the period between 1980 and 1985 (1). The similar timing of the increase in brain cancer incidence and the decline in aspirin use is likely coincidental for the following reasons: 1) The use of antipyretics in children is almost exclusively episodic and lasts for brief treatment courses during acute infections. On the other hand, the use of aspirin for the prevention of colon adenomas and cancers appears to require prolonged, regular usage over many years (2). 2) While there are well-documented animal models that provide a convincing preclinical rationale for the role of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) as chemopreventive agents for colon cancer (3), there are no animal models that show a preventive effect for aspirin and NSAIDs against brain cancers. 3) Both case-control and cohort epidemiologic studies have revealed a substantial reduction in the risk of colorectal cancer among regular users of aspirin. For example, multiple studies have demonstrated that persons with rheumatoid arthritis, a population that ingests large amounts of aspirin for prolonged periods, have lower than expected rates of colorectal cancer (4). However, epidemiologic studies suggest that the chemopreventive effects of aspirin for colorectal cancer do not apply broadly to other types of cancer (5,6). Specifically, diminished rates of brain cancer have not been reported for patients with rheumatoid arthritis, and some reports have noted a somewhat higher than expected incidence for brain cancer among these patients (6).
