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Table of Contents
Band 27, No. 4, 2011
Issue release date: August 2011
Viszeralmedizin 2011;27:322–328
(DOI:10.1159/000331228)

Chemoprevention

Burn J.
Institute of Genetic Medicine, International Centre for Life, Newcastle University, Newcastle upon Tyne, UK

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Abstract

Observational studies show that aspirin reduces colorectal cancer (CRC), especially with prolonged use. In four adenoma prevention randomized controlled trials (RCTs), aspirin at any dose reduced the risk of a colorectal adenoma by an average of 17% and advanced adenomas by 28%. Registry follow-up for a median of 18 years after five RCTs showed that treatment with any aspirin dose reduced the 20-year CRC risk by 24% and the CRC-associated mortality by 35%. A meta-analysis of eight trials with a total of 25,570 patients showed a 21% lower risk of death from any cancer. The trial CAPP1(Concerted Action Polyposis Prevention 1) tested aspirin 600 mg/day and/or resistant starch 30 g/day in 200 adolescent familial adenomatous polyposis carriers. Aspirin treatment resulted in a non-significant reduction in polyp number and a significant reduction in polyp size among patients treated with aspirin for more than 1 year. The CAPP2 RCT used the same interventions in 937 Lynch syndrome (LS) patients, which was the first RCT to have cancer prevention as a primary endpoint. Aspirin did not reduce the risk of colorectal neoplasia in a mean treatment period of 29 months but double-blind post-intervention follow-up has revealed that 48 participants developed 53 CRCs. Protocol analysis showed 60% fewer cancers with aspirin (p = 0.02) apparent from 4 years, with a similar effect on other LS cancers. CAPP3 will involve a double-blind dose inferiority trial comparing 100, 300 or 600 mg daily in 3,000 gene carriers. We can now recommend aspirin in people at high risk of CRC.



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