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Top Line: Lots of evidence suggest that regular aspirin intake reduces risk of colon adenomas, incidence of colon cancer, and risk of colon cancer recurrence.
The Study: People with Lynch syndrome have defects in DNA mismatch repair genes that lead to an increased risk of cancer—particularly colon and endometrial cancer. In fact, Lynch syndrome is the most common form of inherited colorectal cancer. This begs the question of whether aspirin can reduce that risk. In the CAPP2 study, over 850 patients ≥25 years old with histories of a cured Lynch-associated neoplasm and “largely intact” colons were randomized to 600 mg aspirin versus placebo daily for at least 2 years and an optional additional 2 years. This report is the final analysis after all patients reached 10 years of follow-up. Indeed, aspirin resulted in a significant reduction in the risk of colorectal cancer in both the intention-to-treat (HR 0.65) and the per-protocol (HR 0.56) populations. The rate of colorectal cancer was 9% with aspirin versus 13% without, and the rate of all Lynch-associated cancers was 17% with aspirin and 21% without—the latter a significant finding in the per-protocol (HR 0.63) population. Rates of colorectal cancer began to diverge 5 years after intervention and persisted over time, suggesting a durable protective effect from limited duration aspirin.
TBL: For people with Lynch syndrome, taking 600 mg aspirin daily for only 2-4 years reduces the risk of developing both colorectal cancer and other Lynch-associated cancers. | Burn, Lancet 2020