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• W2000295054 abstract "The study by John Burn and colleagues1Burn J Gerdes AM Macrae F et al.on behalf of the CAPP2 InvestigatorsLong-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial.Lancet. 2011; 378: 2081-2087Summary Full Text Full Text PDF PubMed Scopus (734) Google Scholar 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.2Chen YL Chang CL Chen HC et al.Major Adverse upper gastrointestinal events in patients with ST-segment elevation myocardial infarction undergoing primary coronary intervention and dual antiplatelet therapy.Am J Cardiol. 2011; 108: 1704-1709Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar 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 colleagues3Rothwell PM Fowkes FG Belch JF Ogawa H Warlow CP Meade TW Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials.Lancet. 2011; 377: 31-41Summary Full Text Full Text PDF PubMed Scopus (1184) Google Scholar 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.4Moayyedi P Jankowski JA Does long term aspirin prevent cancer?.BMJ. 2010; 341: c7326Crossref PubMed Scopus (11) Google ScholarIn 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.5Jankowski J Barr H Wang K Delaney B Diagnosis and management of Barrett's oesophagus.BMJ. 2010; 341: c4551Crossref PubMed Scopus (51) Google ScholarJJ is chief investigator of the AspECT trial and a consultant to AstraZeneca. HB is a member of the AspECT trial management group. PM is deputy chief investigator of the AspECT trial. The study by John Burn and colleagues1Burn J Gerdes AM Macrae F et al.on behalf of the CAPP2 InvestigatorsLong-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial.Lancet. 2011; 378: 2081-2087Summary Full Text Full Text PDF PubMed Scopus (734) Google Scholar 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.2Chen YL Chang CL Chen HC et al.Major Adverse upper gastrointestinal events in patients with ST-segment elevation myocardial infarction undergoing primary coronary intervention and dual antiplatelet therapy.Am J Cardiol. 2011; 108: 1704-1709Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar 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 colleagues3Rothwell PM Fowkes FG Belch JF Ogawa H Warlow CP Meade TW Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials.Lancet. 2011; 377: 31-41Summary Full Text Full Text PDF PubMed Scopus (1184) Google Scholar 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.4Moayyedi P Jankowski JA Does long term aspirin prevent cancer?.BMJ. 2010; 341: c7326Crossref PubMed Scopus (11) Google Scholar 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.5Jankowski J Barr H Wang K Delaney B Diagnosis and management of Barrett's oesophagus.BMJ. 2010; 341: c4551Crossref PubMed Scopus (51) Google Scholar JJ is chief investigator of the AspECT trial and a consultant to AstraZeneca. HB is a member of the AspECT trial management group. PM is deputy chief investigator of the AspECT trial. Does aspirin really reduce the risk of colon cancer? – Authors' replyWe are grateful to John Cleland for his thoughtful response to our article, but nothing in his letter changes our conclusions. The planned primary analysis of the CAPP2 study—ie, the effect of 600 mg aspirin per day for 2 years on colorectal cancer in carriers of Lynch syndrome—is in the paper in The Lancet.1 The 2008 paper, based on exit colonoscopy data at the end of intervention, examined the secondary endpoint of the effect of aspirin on adenoma formation. We were surprised by the complete lack of effect on adenoma formation, but the effect on cancer development in our primary endpoint analysis is clear. Full-Text PDF" @default.
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• W2000295054 title "Does aspirin really reduce the risk of colon cancer?" @default.
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