Commentary: Does aspirin really reduce the risk of colon cancer? : The Lancet

Does aspirin really reduce the risk of colon cancer? : The Lancet

Does aspirin really reduce the risk of colon cancer?

The study by John Burn and colleagues1 is unquestionably a superb piece of work that opens the door to formalised chemoprevention in young carriers of Lynch syndrome. However, setting aside the fact that the primary intention-to-treat analysis was not significant, there is a need to address whether these data are applicable to others at need of chemoprevention.

Specifically, the study included a predominantly young population with a mean age at recruitment in the early 40s and a mean follow-up of 5 years. Therefore the current age of participants is about 50 years. At this age, the frequency and severity of aspirin complications is very low.2 Indeed the number of adverse events quoted in the paper's appendix is only 21 in more than 400 aspirin-taking patients. Moreover, Rothwell and colleagues3 have indicated that, for the general public or those at risk of more common cancers, taking aspirin before 55 years of age will not have a significant benefit. Furthermore, the mean period of treatment is just more than 2 years and although this suggests an impressive effect, it means that the long-term safety is unknown.4

In conclusion, although this study is excellent news for patients with Lynch syndrome, we need data from other large and long-term randomised trials with cancer endpoints such as the AspECT trial to assess the safety of aspirin in an older and more general population.5