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

abstract: Hormone prevention strategies for breast, endometrial and ovarian cancers

"Prospective, randomized trials, designed to control for all known variables, are mandatory to fully assess the potential for hormonal chemoprevention in breast, endometrial and ovarian cancers."

abstract: Hormone prevention strategies for breast, endometrial and ovarian cancers

"The prevention of epithelial ovarian cancer (EOC) is of particular interest given its high mortality rate and the lack of a cost-effective screening program. OC (oral contraceptives) usage significantly diminishes the incidence of EOC, in both the general population, as well as in patients with BRCA 1 or 2 mutations. Risk reduction is greatest with prolonged usage and persists for more than 30 years after OC use, but diminishes over time. Prospective, randomized trials, designed to control for all known variables, are mandatory to fully assess the potential for hormonal chemoprevention in breast, endometrial and ovarian cancers."

Medical News: SGO: Hint of Chemoprevention Potential for Lynch Syndrome (endometrial cancers) - in Meeting Coverage, SGO

SAN FRANCISCO -- Oral contraceptives and medroxyprogesterone acetate (MPA, DepoProvera) may have potential as chemopreventive agents for endometrial cancer in women with Lynch syndrome, biomarker data from a small randomized trial suggest.
"Despite the favorable results, Lu noted that the trial required six years to complete, as investigators in the multicenter study had to screen 708 patients to identify 51 who met entry criteria and agreed to participate, including undergoing two endometrial biopsies three months apart."

read the full article & then my comments as below:

Without the benefit of the full paper, I found this article, in part to be quite confusing. In particular "screened women with diagnosed Lynch syndrome". While the first paragraph of the article reflects the focus on endometrial cancer in women with Lynch Syndrome, the paragraph as below, could also be interpreted to include ovarian cancer as well. So, were ovarian cancer patients with Lynch Syndrome included in this study? Chemoprevention in the form of oral contraceptives in the general ovarian cancer populations is well understood, whether or not this applies to ovarian cancer women with Lynch Syndrome may be yet to be determined.
Clarification, please?
Sandi Pniauskas

"To examine the chemopreventive effects of oral contraceptives and DepoProvera in women with Lynch syndrome, investigators conducted a randomized phase II clinical trial. They screened women with diagnosed Lynch syndrome and evaluated them with transvaginal ultrasound and endometrial biopsy."