Aspirin Use Is Protective Against Gastric Cancer in a High-Incidence Region of Central America

Samara B Rifkin; Eleazar Enrique Montalvan-Sanchez; Dalton A Norwood; Dagoberto Estevez-Ordonez; Daniela Montalvan-Sanchez; Aida Rodriguez-Murillo; Ricardo L Dominguez; Douglas R Morgan

doi:10.1007/s10620-025-09042-7

Aspirin Use Is Protective Against Gastric Cancer in a High-Incidence Region of Central America

Dig Dis Sci. 2025 Jun 6. doi: 10.1007/s10620-025-09042-7. Online ahead of print.

Authors

Samara B Rifkin¹, Eleazar Enrique Montalvan-Sanchez², Dalton A Norwood³, Dagoberto Estevez-Ordonez⁴, Daniela Montalvan-Sanchez⁵, Aida Rodriguez-Murillo⁵, Ricardo L Dominguez⁵, Douglas R Morgan⁶

Affiliations

¹ Department of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
² Digestive Disease Section, Yale School of Medicine, New Haven, CT, USA.
³ Division of General Internal Medicine and Population Science, UAB, The University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Department of Neurosurgery, UAB, The University of Alabama at Birmingham, Birmingham, AL, USA.
⁵ Hospital de Occidente, Ministry of Health, Santa Rosa de Copan, Copan, Honduras.
⁶ Division of Gastroenterology and Hepatology, UAB, The University of Alabama at Birmingham, Birmingham, AL, USA. drmorgan@uabmc.edu.

PMID: 40478405
DOI: 10.1007/s10620-025-09042-7

Abstract

Purpose: Gastric cancer is a leading cause of cancer-related deaths in Central America, where Helicobacter pylori infection is highly prevalent. This study aimed to assess the association between regular use of aspirin (ASA) and nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk of gastric adenocarcinoma in this high-incidence region.

Methods: A case-control study was conducted with 1067 incident cases of gastric cancer and 1745 controls. Helicobacter pylori and CagA status were evaluated for 1009 cases and 1557 controls. Demographic, lifestyle, and ASA/NSAID use data were collected via structured interviews. Logistic regression models estimated odds ratios (ORs) and adjusted ORs (aORs) for the relationship between ASA/NSAID use and gastric cancer risk, controlling for demographic and clinical factors.

Results: The prevalence of H. pylori and CagA-positive infection were 90.0% and 85%, respectively. Significant tobacco and alcohol use were limited, 3.6% and 1.8%, respectively. Logistic regression revealed that ASA use was inversely associated with gastric cancer risk, with an unadjusted OR of 0.73 (95% CI 0.40, 1.26), and adjusted aOR of 0.49 (95% CI 0.26, 0.91). NSAID use showed no significant association after adjustment (aOR: 1.18; 95% CI 0.75, 1.87).

Conclusion: Regular ASA use is associated with a significant reduction in gastric cancer risk, while NSAID use showed no significant protective effect. Future research should include controlled trials, and the cost-benefit trade-off between ASA's protective effects and gastrointestinal bleeding risks.

Keywords: Aspirin; CA-4; Central America; Gastric cancer; Honduras; LMIC; Latin America.

Grants and funding

R01 CA190612/CA/NCI NIH HHS/United States