But new research is revealing something about aspirin and cancer that changes the story in ways nobody expected. It starts with a completely different way of looking at what drugs actually do to cancer cells. And it ends with a finding that turns decades of assumptions upside down.

How Cancer Drugs Have Always Been Tested — and Why It Misses So Much

For as long as modern cancer research has existed, scientists have tested drugs the same basic way. They put cancer cells in a dish, add the drug, and wait to see if the cells die. If most of them die, the drug is a winner. If they survive, the drug gets tossed.

This sounds perfectly reasonable. But stop and think about what it actually measures. It measures one thing and one thing only: death. Here's the problem with that.

•Cancer isn't just one thing going wrong — A cancer cell is a normal cell that has gone haywire in many ways at the same time. Think of it like a car where the engine is racing, the brakes are cut, and the steering is locked — all at once. Killing the car — running it into a wall — is one way to stop the problem. But what if you could just fix the engine, unlock the steering, reconnect the brakes, and turn the headlights back on? You would have a working car again.

•Cancer cells aren't alien invaders — They're your own cells running the wrong program. And a drug that could fix part of that program — slow the engine down, reconnect some of the brakes — would be completely invisible in the standard drug test, because the cells didn't die. How many valuable drugs have been thrown in the trash because we were only looking at one thing?

Every Cell Runs a Program — Cancer Cells Are Running the Wrong One

To understand the new approach, you first need to understand one simple idea about how your cells work.

•Every cell in your body contains the same DNA, the same complete set of instructions — What makes a colon cell different from a brain cell or a skin cell is not which instructions they have, but which instructions they're actually using. Out of roughly 20,000 genes, each cell type switches on a specific set and keeps the rest turned off. This pattern — which genes are on and which are off — is the cell's program. It is what gives the cell its identity.

•Think of it like a massive mixing board in a recording studio — There are 20,000 sliders. A healthy colon cell has each slider set to a very specific position. The overall setting produces "healthy colon cell." When a cell becomes cancerous, the sliders get moved. Some that should be turned down get cranked up. Others that should be up get pushed to zero.

The mixing board is still there, the sliders still work, but the overall setting now produces "cancer cell" instead of "healthy colon cell." This is a crucial point. The cancer cell hasn't been destroyed or replaced. It's your cell, running the wrong settings.

A 100-Million-Cell Dataset Made a New Question Possible

Researchers at a company called Tahoe Therapeutics have built something that has never existed before.1 They measured how 1,100 different drugs changed the genetic settings in cancer cells — one cell at a time — across 50 different cancer cell lines. The result is a dataset containing 100 million individual cell measurements from 60,000 separate drug experiments. That's 50 times more data than everything publicly available before it — combined.

•With this enormous dataset, they could finally ask the question that nobody had enough data to answer before — For every drug, does it push the cancer cell's gene settings back toward the healthy pattern? Here's how they did it. First, they used data from real colon cancer patients to map out exactly how the gene settings differ between healthy colon tissue and cancerous colon tissue. That gave them the "disease signature" — a precise measurement of what went wrong.

•Then, for each drug in their collection, they measured what it did to the mixing board — Did it move the sliders back toward the healthy positions? Or did it push them even further in the wrong direction? Or did it just move them to some random new pattern?

•They scored every drug with a simple number — A strong negative score meant the drug was reversing the cancer pattern — pushing the cell back toward normal. They call this "cell-state reversal."2

The First Test: Does It Match What Doctors Already Know?

Before you trust a new method, you need to check it against reality. If drugs that are already proven to work in colon cancer patients don't score well on this test, the whole approach is worthless. So, the researchers checked. And the results were clear.

•Top-scoring drugs matched the exact mutations driving colon cancer growth — The drugs that scored highest for pushing colon cancer cells back toward normal were exactly the ones that target the specific genetic mutations most commonly found in colon cancer — MEK inhibitors, BRAF inhibitors, KRAS inhibitors, and PI3K pathway inhibitors.

These are the drugs oncologists already use because clinical experience has shown they work. The framework figured this out on its own, from the data alone, without being told which drugs are effective in patients.

•It even caught subtleties that match real clinical practice — Among chemotherapy drugs, the ones that target DNA — like 5-fluorouracil and oxaliplatin, which are the backbone of standard colon cancer treatment — scored higher than the ones that target the cell's internal scaffolding, called microtubule inhibitors. Microtubule inhibitors aren't part of the standard treatment for colon cancer, and the data reflected that perfectly.

Now Here's Where It Gets Really Interesting: The Aspirin Surprise

Among all the drugs tested, one result stood out as genuinely unexpected. It involved one of the cheapest, oldest, and most widely available medicines on Earth.

When the researchers looked at aspirin and its close chemical relatives in the dataset, they found that sodium salicylate — which is aspirin with one specific piece removed — produced stronger cancer-state reversal than aspirin itself. To understand why this is such a big deal, you need to know one thing about aspirin's chemistry. Don't worry — it is simpler than it sounds.

•Aspirin's chemical name is acetylsalicylic acid — It's made of two parts: salicylic acid, which comes from willow bark and has been used as medicine for thousands of years, and an acetyl group, which was attached to the salicylic acid by chemists at Bayer in 1897 to make it easier on the stomach.

•That acetyl group isn't just a packaging improvement — It's the part that gives aspirin its most famous ability — the power to shut down an enzyme called cyclooxygenase, or COX for short. COX produces inflammatory chemicals called prostaglandins. When aspirin blocks COX, inflammation goes down.

That's how aspirin reduces pain, reduces fever, thins your blood, and — most researchers assumed — fights cancer. Here's the catch. If aspirin's anticancer power comes from blocking COX, then removing the acetyl group — the part that does the COX blocking — should make it worse at fighting cancer, not better.

•But the Tahoe data showed the exact opposite — Salicylate, without the acetyl group, was better at reversing the cancer cell's genetic program than aspirin with it. That means the cancer-fighting effect isn't coming from COX inhibition. It's coming from the salicylate itself — through a completely different mechanism that nobody was paying attention to.

So, What Is Salicylate Actually Doing? The Answer Is Elegant

The Tahoe data showed what salicylate does to cancer gene patterns. But other research teams have been uncovering how it does it, and the picture is remarkably coherent. Your cells have an energy sensor — think of it as a fuel gauge.

It's a protein called AMPK, which stands for AMP-activated protein kinase, but all you need to know is that AMPK is the alarm system that goes off when your cell's energy balance changes.3 It's one of the most powerful metabolic switches in your body. Salicylate switches AMPK on.4 When AMPK activates, it triggers a chain of events that's devastating to cancer cells. Here's the chain, step by step:

•Step 1: AMPK shuts down c-MYC — One of the most important genes in cancer is called c-MYC. Think of c-MYC as the gas pedal for cell growth. In a healthy cell, it's carefully controlled. In many cancers — especially colon cancer — c-MYC is jammed to the floor, driving the cell to grow and divide nonstop. Salicylate-activated AMPK grabs c-MYC and tags it for destruction. The gas pedal gets released.

A 2025 study using a mouse model of colon cancer confirmed this. Mice given salicylate had dramatically lower c-MYC levels in their colon cells, and they developed fewer tumors.5

•Step 2: With c-MYC gone, a protective system switches on — Here's something beautiful about your biology. You already have a built-in tumor defense system — a set of genes that suppress cancer. One of the most important is a group of tiny molecules called miR-34a and miR-34b/c.6 These are microRNAs — small pieces of genetic material that act like off-switches for cancer-promoting genes. They work by silencing specific genes that cancer cells depend on to grow and spread.

Normally, a protein called NRF2 — think of it as your cell's fire alarm system — is supposed to activate these cancer-fighting microRNAs. But c-MYC sits on top of NRF2 and keeps it silenced. It's like a bully sitting on the fire alarm so nobody can pull it. When salicylate removes c-MYC, NRF2 is free. It activates miR-34a and miR-34b/c. Your body's own tumor suppression system comes back online.

•Step 3: The cancer cells lose their ability to spread — When researchers blocked miR-34a and miR-34b/c in the lab, salicylate's ability to stop cancer cell migration and invasion largely disappeared. That tells you these microRNAs are the key weapons. Salicylate isn't directly attacking the cancer — it's rearming your body's own defense system.

•And here's the most important part — Normally, miR-34 depends on a tumor suppressor gene called p53 — often called the "guardian of the genome." But p53 is the single most commonly broken gene in human cancer. In more than half of all cancers, p53 doesn't work. Salicylate's pathway bypasses p53 entirely. It activates miR-34 through NRF2 instead.

This means it could theoretically work in the very cancers that have already lost their most important natural defense, which is exactly the cancers that need help the most. None of this involves COX inhibition. None of it requires the acetyl group. This is the ancient willow bark compound doing something we are only now beginning to understand.

The Clinical Trial That Changed the Guidelines

While these laboratory discoveries were piling up, a major clinical trial was delivering results that would change how oncologists treat colon cancer. The trial used aspirin, not salicylate — but remember, your body rapidly strips the acetyl group off aspirin and converts it into salicylic acid. So, every aspirin patient in this trial was effectively being dosed with salicylate.

The ALASCCA trial, published in the New England Journal of Medicine in September 2025, was the gold standard of medical research — a double-blind, randomized, placebo-controlled trial, meaning neither the patients nor the doctors knew who was getting aspirin and who was getting a sugar pill.7

It was conducted across 33 hospitals in four countries: Sweden, Denmark, Finland, and Norway. The trial focused on patients with stage I through III colon and rectal cancer whose tumors carried mutations in something called the PI3K pathway — a growth-signaling system that, when broken, helps cancer cells multiply unchecked. You don't need to remember that name.

What matters is that these mutations are found in more than one-third of all colorectal cancers — so this isn't a rare subtype. It is a big chunk of patients. After surgery, patients were randomly assigned to take either 160 milligrams (mg) of aspirin or a placebo every day for three years.

•The results were remarkable — Among patients with the most common type of PI3K mutation, aspirin cut the three-year recurrence rate roughly in half — from 14.1% with placebo down to 7.7% with aspirin.

The benefit held up across every subgroup the researchers checked: men and women, all disease stages, colon and rectal cancer, and regardless of whether patients also received chemotherapy. Lead researcher Anna Martling of the Karolinska Institutet in Stockholm called it "a clear example of how we can use genetic information to personalize treatment and at the same time save both resources and suffering."8

•The National Comprehensive Cancer Network has since updated its recommendations — This organization, which writes the treatment guidelines oncologists follow, now formally recommend genetic testing for PIK3CA mutations in stage II-III colon cancer, and for patients who carry the mutation, three years of low-dose aspirin after surgery.9 This makes aspirin one of the first dirt-cheap, widely available drugs to be officially integrated into precision cancer treatment guidelines.

Aspirin Also Helps Your Immune System See the Cancer

The ALASCCA trial proved aspirin works in patients. But there's another dimension to the story — aspirin may also be helping your immune system do its own cancer-fighting job. A 2024 study published in the journal Cancer found that regular aspirin use was linked to activation of immune surveillance in colorectal cancer patients.10 Here's what that means in plain English.

•Your immune system is supposed to recognize and destroy cancer cells — That's one of its main jobs. But cancer cells are sneaky — they learn to hide from your immune system by covering up the markers that would identify them as abnormal.

•Regular aspirin use linked to less spread and stronger immune attack — The researchers found that colon cancer patients who regularly used aspirin had two things going for them. First, they had fewer cancer cells that had spread to their lymph nodes. Second, they had more immune cells infiltrating their tumors — meaning the immune system was actually showing up to fight.

•Aspirin helps cancer cells reveal themselves to immune system defenses — When they treated colon cancer cells with aspirin in the lab, they found aspirin increased the expression of a protein called CD80 on the surface of the cancer cells. CD80 is like a flag that says "I am abnormal — come get me."

It helps cancer cells present themselves to your T cells — the soldiers of your immune system — so they can be recognized and destroyed. In simple terms, aspirin was pulling the camouflage off the cancer cells so the immune system could see them.

Aspirin's Benefits Go Far Beyond Cancer

As I've detailed in previous articles, aspirin's health benefits reach into nearly every major organ system. Here's an updated picture based on the latest research.

•Your liver — A clinical trial found that 81 mg of aspirin daily led to a 17.3% decrease in the amount of fat stored inside liver cells over six months, while patients taking a placebo saw their liver fat increase by 30.3%.11 Aspirin also improved markers of inflammation and scarring in the liver — two key factors in the progression of fatty liver disease.

•Your blood sugar — An analysis of 16,209 adults aged 65 and older found that low-dose aspirin was associated with a 15% lower risk of developing Type 2 diabetes and a slower rise in fasting blood sugar levels over time.12

•Your survival in critical care — A large study of 146,191 intensive care unit (ICU) patients found that aspirin use during ICU stays was linked to significantly lower death rates within 28 days, particularly in patients with widespread inflammation.13

•Your brain — Research found that low-dose aspirin use for more than 10 years was associated with a 31% reduced risk of Alzheimer's disease, a 69% reduced risk of vascular dementia, and a 54% reduced risk of dementia from any cause — particularly in patients who already had heart disease.14

•Your lungs — Aspirin has been shown to reduce the scarring process in lung tissue by switching on a cellular recycling system called autophagy — your cells' built-in method of cleaning out damaged proteins and preventing scar tissue from building up. When researchers blocked autophagy, aspirin's anti-scarring effects disappeared, confirming that this recycling process is how aspirin protects the lungs.15

•Your metabolism — Aspirin helps your cells burn glucose for energy, reduces the release of linoleic acid (LA) — a harmful omega-6 fat — from your fat stores, lowers your cortisol levels, and increases your metabolic rate by partially uncoupling your mitochondria.16 Think of uncoupling as your cellular engines running a bit hotter and burning more fuel, which is why aspirin may help with weight management.

What About Salicylate and Willow Bark?

The Tahoe finding — that salicylate reversed the colon cancer gene signature more strongly than aspirin — has a practical implication that's easy to overlook. When you take aspirin, your body quickly strips off the acetyl group and converts it into salicylic acid. That is what circulates in your bloodstream. That is what your cells actually see.

•Aspirin's lasting anticancer effects stem from its salicylate metabolite — The acetyl group does its COX-blocking work during the brief window before it gets removed, but the salicylate metabolite is what sticks around and does the long-term work.

This means the anticancer effects are most likely coming from the part of aspirin that's identical to what you would get from willow bark — the plant medicine that humans have used for thousands of years, long before Bayer attached an acetyl group to it in 1897.

•Willow bark provides the same active compound linked to anticancer benefits — If you're sensitive to aspirin — if it bothers your stomach or you can't take it for other reasons — this is important news. A salicylic acid supplement or willow bark extract delivers the very compound that the largest drug-response dataset in history identified as more effective than aspirin at pushing cancer cells back toward normal.

•Standardized willow bark dosing approximates common low-dose aspirin effects — For dosage, to approximate the effects of 81 mg of aspirin, you would need 400 mg to 800 mg of willow bark extract standardized to 15% salicin. To match the effects of a full 325 mg aspirin, you would need roughly 1 to 2 grams of standardized extract.

•Immediate-release aspirin with minimal additives aligns best with research dosing — If you prefer aspirin, opt for immediate-release, uncoated versions. Avoid coated extended-release formulations because of their additives. Check the inactive ingredients list — corn starch should be the only one listed. A dosage of 81 mg to 325 mg daily, taken with your largest meal, is the range supported by the current research.

Why This Changes How We Think About Medicine

Step back for a moment and consider what's happened here. For decades, the entire cancer drug discovery pipeline has been built around one question: does this drug kill cancer cells? Billions of dollars, thousands of clinical trials, an entire industry — all oriented around cell death as the primary measure of success.

Now, using the largest dataset of its kind ever assembled, researchers have shown that you can score drugs by a completely different measure — how well they push diseased cells back toward being healthy cells. And when they did this, the results matched known clinical reality with remarkable precision.

•More importantly, this approach revealed something that the old method couldn't see — A simple, ancient, inexpensive compound — salicylate, the active heart of willow bark — is doing something to colon cancer cells that ranks alongside purpose-built targeted cancer drugs. Not by killing the cells. By fixing them.

•This framework applies anywhere a disease is fundamentally a cell running the wrong program — Autoimmune conditions where immune cells attack your own body. Brain diseases where neurons lose their specialized function. Scarring diseases where cells produce too much fibrous tissue.

In all of these cases, the right question is not "can we kill the cell" but "can we push the cell back toward normal." How many other cheap, safe, widely available compounds have cancer-fighting properties that we have completely missed because we were only measuring the wrong thing? We may be about to find out.

The Bottom Line

We've spent decades arguing about aspirin and cancer while asking the wrong questions. We asked whether aspirin kills cancer cells. The answer was not very impressive. We asked whether aspirin's anti-inflammatory COX inhibition reduces tumor-promoting inflammation. The evidence was mixed.

But now, using 100 million cell measurements and a fundamentally different scoring method, we can see that salicylate — the ancient compound at the heart of aspirin, the same molecule found in willow bark — is doing something far more sophisticated than anyone imagined.

It's not just killing cancer cells or reducing inflammation. It switches on your cells' energy sensor, shuts down a major cancer-driving gene, reactivates your body's built-in tumor defense, and pushes cancer cells back toward normal.

And it does all of this through a pathway that has nothing to do with COX inhibition — the mechanism many people assumed was responsible. This is a common, safe, inexpensive medicine whose full power we are only now beginning to understand — and it deserves far more attention than it's getting.