Reply to: Second primary malignancies in myeloproliferative neoplasms and the role of aspirin

The letter of Lucijanic et al. [1] raises the question of a possible carcinogenic role of aspirin (ASA) in myeloproliferative neoplasms (MPN). The concern is based on the results of the ASPREE randomized clinical trial (Aspirin in Reducing Events in the Elderly) that investigated whether the daily use of 100 mg of enteric-coated aspirin would prolong the healthy life span of older adults [2]. The primary end point of ASPREE was disability-free survival, defined as survival free of dementia or persistent physical disability. The use of low-dose aspirin did not impact significantly compared with placebo in reducing the rate of primary end point after a median of 4.7 years of follow-up. Surprisingly, and in contrast to meta-analyses of previous randomized prevention trials of aspirin that showed a protective effect of aspirin on cancer-related death [3], the above study reported an increased cumulative incidence of cancer-related death in healthy elderly in comparison to placebo (Hazard Ratio: 1.31; 95% CI 1.10–1.56) and this event was only minimally related to major bleeding.