Aspirin to prevent colorectal cancer

The people at very high genetic risk could benefit.

The hope of a preventive treatment of cancer motivates all the researchers but also the people presenting very high risks. This is the case of those with Lynch syndrome, a genetic irregularity that significantly raises the risk of cancer, including colorectal cancer but also other organs such as the endometrium. In this rare syndrome, which is the most familiar cause of inherited colorectal cancer, people must undergo colonoscopies at most every two years from the age of twenty years. The goal is of course to detect early colo-rectal cancer that is known to affect more than one of these person in three.

The research writen recently in the world journal The Lancet, should bring some hope to those people for whom the average age of coming out of colorectal cancer is 42 years (sometimes even before 25 years).

This work indeed shows the preventive role of aspirin. In more than 850 patients, half taking aspirin and half taking a placebo, it appears that people who took 600 mg of aspirin every day for 2 years had a reduced risk of colorectal cancer. One 3rd compared to those using a placebo (inactive product). And that without particular secondary effects. The writers observed eighteen cancers for 427 people in the aspirin team against 30 for 434 people treated with placebo.

A solid foundation

In 2008, these same researchers had not proven the absolute efficacy of aspirin in this study. It was by prolonging the surveillance of these people who took aspirin for more than 2 years that they became aware of the preventive effect of aspirin. After 2 years, the difference between the two groups began to appear but was still statistically insufficient to write any conclusions.

Cautious optimism of Dr. David Malka, digestive oncologist at the Institut Gustave-Roussy (Villejuif): "This is a reaserach that could add a new power next to the surveillance of patients by colonoscopy," he says. This time, Professor John Burn (Institute of Genetic Medicine, University of Newcastle) and his colleagues are more categorical: "Our results, put forward with other recent research, provide a quite solid base for prescibing aspirin in systematic prevention. In Lynch syndrome, they write in The Lancet. According to them, what is left is to determine the specific dose and the specific duration of treatment.

Experts are surprised, however, to reach this ending while the amount of polyps found by colonoscopy was the same that patients take aspirin or placebo. The theory is that polyps are the first step before a possible transformation into cancer. Can these results obtained in patients at very high risk, because of their genetic disease, be extrapolated to other categories? What is the gain / risk ratio of treatment in these cases, because of the risk of bleeding related with aspirin? For the moment, the results obtained with here the low doses of aspirin used in the prevention of periodic of cardiovascular events, generally less than 100 mg per day, have not shown any interest in lowering the risk of colorectal cancer. In contrast, for people with colorectal cancer cured, researches have shown a preventive but moderate effect of aspirin. It is still quite early to dare a general recommendation aside from Lynch Syndrome.

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