RESPONSE: Re: A Prospective Study of Aspirin Use and the Risk of Pancreatic Cancer in Women

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We thank Dr. Gensini et al. for their interesting contribution. They suggest that we, as well as other authors of observational studies, should always provide number needed to treat (NNT) and number needed to harm (NNH) to assess risk–benefit profiles for public health recommendations. Our analyses, based on data from the Nurses’ Health Study cohort, revealed an elevated pancreatic cancer risk among women who reported extended periods of regular aspirin use (1).

Aspirin is widely used, both in therapeutic and preventive health care settings. In addition to its well-established beneficial effects on cardiovascular risk, there is good evidence for a protective effect of aspirin on colon carcinogenesis (2). There are also risks associated with the use of aspirin, such as higher risks for gastrointestinal bleeding and cerebral hemorrhage. Thus, a full risk–benefit analysis of regular aspirin use actually goes well beyond the concept of NNH and NNT for pancreatic cancer only.