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Question clinique
Does aspirin prevent colorectal cancer in carriers of hereditary nonpolyposis colorectal cancer (Lynch syndrome)?
L’Essentiel
After an average of 10 years of follow-up, persons who are carriers of Lynch syndrome who take 2 to 4 years of aspirin have fewer colorectal cancers than those who take a placebo. Aspirin had no effect on non-Lynch syndrome cancers or on noncolorectal Lynch syndrome cancers. 1b
Référence
Plan de l'etude: Randomized controlled trial (double-blinded)
Financement:
Cadre: Outpatient (any)
Sommaire
We previously reported data from the CAPP2 study in which patients who were carriers of hereditary nonpolyposis colorectal cancer (Lynch syndrome) were randomized to receive 600 mg aspirin daily (n = 427) or placebo (n = 434) for 2 years with an option to continue for an additional 2 years. At the time of the initial report, there was no significant reduction in cancers in the intention-to-treat analysis, but there was a significant reduction in cancers using a per-protocol analysis. This paper reports the outcomes of a longer term follow-up of this study. The authors used national cancer registries to provide data for up to 20 years after randomization. This resulted in an average follow-up duration of 10 years during which time 40 (9.4%) of the aspirin-treated participants developed colorectal cancer compared with 58 (13.4%) of the control patients (number needed to treat = 25). Although other cancers are also associated with Lynch syndrome (eg, endometrial, ovarian, and pancreatic), aspirin did not reduce these other cancers and it didn't reduce non-Lynch syndrome cancers. The authors don't report on the harms of aspirin during the treatment period.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI