Let’s discuss the prevention of cancer. Prevention of cancer is the topic of your lifelong research interests. Dr. Anton Titov, MD. There is a lot of information about the nutrition and lifestyle modifications to prevent cancer. We learn every day how the interplay of nature and nurture affects cancer risks. But chemoprevention is also potentially important. Chemoprevention means the use of pharmaceuticals in cancer prevention. Dr. Anton Titov, MD. One of the widely available medications is Aspirin. You have shown that Aspirin has a preventive role for several cancers. Dr. Anton Titov, MD. What is the role of Aspirin in a prevention of cancers? Which cancers are likely to be prevented by Aspirin? Dr. Jack Cuzick, PhD. Yes, I must say I am very excited about the role of Aspirin in prevention of cancer. Because Aspirin (acetylsalicylic acid) can prevent a range of cancers. There is clear evidence that Aspirin produces about a one-third [30%] reduction in colorectal cancer, stomach cancer and esophageal cancer. There is less clear evidence of smaller reduction of breast cancer, prostate cancer, and lung cancer. The prevention effect is about 10% for these cancers. The evidence for cancer-preventive effect of Aspirin is consistent. Dr. Jack Cuzick, PhD. We still have to do more research on the use of aspirin in a prevention of breast cancer, prostate cancer, and lung cancer. But effects of aspirin on the other three cancers are very clear. We did a risk assessments of cancer. We looked at the risks and benefits of Aspirin in cancer prevention. We were surprised to find the following fact. If you want to prevent cancer, everybody knows that the most important thing to do is to stop smoking. But, in fact, numerically, the second most important thing you can do to prevent cancer is to take a small "baby" Aspirin. Aspirin dose is 81 mg or 100 mg per day. That is a low-dose Aspirin. You can take aspirin for 5 to 10 years. You can take acetylsalicylic acid between age 50 to 65. So we are very excited to promote the idea of using aspirin for cancer prevention. It's something that is not widely done. Aspirin is an interesting medication. Because we got our first hints about breast cancer prevention in this way. We looked at contralateral tumors in the other breast. You treat patients with breast cancer hormonal medications to prevent recurrence of their primary breast tumor. Breast is a unique organ. There are two breasts. So you can look at a medication’s cancer-preventive effect on the other organ. Similar effects happened with Aspirin. It was not quite the same effects as in tamoxifen. But aspirin had been used a lot to prevent cardiovascular disease. Dr. Jack Cuzick, PhD. There are many clinical trials of low-dose Aspirin to prevent cardiovascular disease. Long-term follow up in these clinical trials showed a very strong evidence. Aspirin makes a strong impact on prevention of cancer. This is a reason it took so long to discover the rope of aspirin in prevention of cancer. It was because not much happens in the first 3 to 5 years after you start taking Aspirin. You don't prevent cancers in the first 3 to 5 years of aspirin use. But after that you get these very big effects on prevention of colorectal cancer, prevention of stomach cancer, prevention of esophageal cancer. Dr. Anton Titov, MD. There is a 30% reduction in stomach cancer, esophageal cancer, and colorectal cancer. All these three cancers are often discovered late in the course of disease. Late diagnosis of colorectal cancer, esophageal cancer and stomach cancer is a major problem in their treatment. But you can take a one small baby Aspirin, 81 mg or 100 mg or 75 mg enteric-coated pills. You can reduce the risk of those cancers by 30%. Dr. Anton Titov, MD. This is an extremely dramatic effect of cancer prevention! I must say I am very excited about it. Dr. Jack Cuzick, PhD. I think aspirin is a medication for cancer prevention that we really have to take very seriously. The cardiologists understood the power of disease prevention a long time ago. Imagine that you go to your cardiologist. The doctor tells you this. "You have high blood pressure. Come back in a year and we will see if you've got a heart attack!”. You would not be very pleased. Dr. Anton Titov, MD. Cardiologists identify high-risk individuals. They prescribe a preventive pharmaceutical therapy for patients at high risk of heart attack. Тhe challenge is to bring that idea into cancer prevention. Aspirin is where we can begin to do that.