Daily high-dose aspirin taken for at least 2 years reduces the risk of colorectal cancer but not other cancers in people with Lynch syndrome
Full article: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30366-4/fulltext
Research has shown that daily aspirin use can reduce the risk of colon and other cancers. The Cancer Prevention Program 2 (CaPP2) study looked at the effect of daily aspirin in patients with Lynch syndrome. After 10 years of follow-up, the results showed that taking daily aspirin for two years reduced the frequency of colon cancer in patients with Lynch syndrome, and importantly, did not result in an increase in side-effects or complications. No benefit was seen for other Lynch syndrome-related cancers, including endometrial cancer. (5/17/21)
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The National Comprehensive Cancer Network (NCCN) provides risk management guidelines for people with Lynch syndrome mutations.
- Colonoscopy every 1-2 years. Speak with your doctor about whether you should be screened yearly or every two years. Men, people over age 40 and individuals with a personal history of colon cancer or colon polyps may benefit most from yearly screenings.
- For people with MLH1, MSH2 or EPCAM:
- beginning between ages 20-25 (or 2-5 years before the earliest age of colon cancer in the family, if diagnosed before age 25).
- For people with MSH6 or PMS2:
- beginning between ages 30-35 (or 2-5 years before the earliest age of colon cancer in the family, if diagnosed before age 35).
- Daily aspirin can decrease the risk of colorectal cancer. The best dose and timing for aspirin are unknown. Speak with your doctor about the benefits, risks, best timing and dose.
Endometrial and ovarian cancer
- Be aware of endometrial and ovarian cancer symptoms.
- Consider endometrial biopsy every 1-2 years beginning between ages 30-35.
- Discuss the benefits and risks of oral contraceptives.
- Consider risk-reducing hysterectomy; discuss risk-reducing removal of ovaries and fallopian tubes with your doctor (EPCAM, MLH1, MSH2 and MSH6 gene mutations).
- Consider annual prostate cancer screening with PSA testing and digital rectal exam.
- For people with a family history of urothelial cancer and men with an MSH2 mutation:
- Consider annual urinalysis beginning between ages 30-35.
- Consider baseline esophagogastroduodenoscopy with random stomach biopsy at age 40.
- consider continuing this surveillance every 3-5 years for people in a high-risk category for gastric cancer.
- Consider testing for H. pylori and treating if the test is positive.
- For people with a family history of pancreatic cancer:
- Consider annual cholangiopancreatography (MRCP) and/or endoscopic ultrasound (EUS) beginning at age 50.
- Consider participating in a pancreatic cancer screening study.
Consider annual physical and neurological exams.
Questions To Ask Your Health Care Provider
- Should I take a daily aspirin to reduce my colon cancer risk?
- What are the benefits and risks of taking a daily aspirin to reduce my colon cancer risk?
- What dose and for how long should I take a daily aspirin to reduce my colon cancer risk?
- What other ways can I reduce my risk of Lynch syndrome-associated cancers?
Open Clinical Trials
The following screening and prevention studies are open to people with Lynch syndrome.
- NCT03805919: Men at High Genetic Risk for Prostate Cancer. This is a prostate cancer screening study using MRI in high-risk men. This study is open to men with Lynch syndrome and other mutations.
- NCT05129605: Prostate Cancer Genetic Risk Evaluation and Screening Study (PROGRESS). This study will look at how well prostate MRI works as a screening tool for men at high risk for prostate cancer. This study is open to men with an inherited mutation in ATM, BRCA1, BRCA2, BRIP1, CHEK2, EPCAM, HOXB13, MLH1, MSH2, MSH6, NBN, PALB2, PMS2, RAD51C, RAD51D, TP53 and other genes.
- NCT02206360: Pancreatic Cancer Early Detection Program. This pancreatic cancer screening study uses esophageal ultrasound to screen for pancreatic cancer in high-risk people. The study is open to people who have a family history of pancreatic cancer and an MLH1 mutation or other mutation linked to increased cancer risk.
- NCT03568630: Blood Markers of Early Pancreas Cancer. This pancreatic cancer study involves blood samples taken over time to look for biomarkers of pancreatic cancer in high-risk people. The study is open to people with an MLH1 mutation or other mutation linked to increased cancer risk.
- NCT03250078: A Pancreatic Cancer Screening Study in Hereditary High-Risk Individuals. The main goal of this study is to screen and detect pancreatic cancer and precursor lesions in individuals with a strong family history or genetic predisposition to pancreatic cancer. MRI and magnetic cholangiopancreatography (MRI/MRCP) will be utilized to screen for early-stage pancreatic lesions.
Other clinical trials for patients with endometrial cancer can be found here.
FORCE is a national nonprofit organization, established in 1999. Our mission is to improve the lives of individuals and families affected by adult hereditary cancers.