New draft guidance says aspirin taken daily could reduce risk of bowel cancer for people with Lynch syndrome

Aspirin taken daily for more than two years could reduce the risk of bowel cancer in people with Lynch syndrome, NICE (The National Institute for Health and Care Excellence) has said in new draft guidance.

People with Lynch syndrome have an increased lifetime risk of developing bowel cancer to up to 80%.

Regular screening with colonoscopy and polypectomy to identify pre-cancerous cells has until now been the main strategy to detect early bowel cancer in people with Lynch and offer appropriate management.

NICE published diagnostics guidance in 2017 recommending that everyone who is diagnosed with bowel cancer should be tested for Lynch syndrome. If the test shows they do have Lynch, they can be monitored for other cancers and their close relatives can also be offered testing. Today’s updated draft guidance recommends aspirin is an option to reduce the risk of bowel cancer among this group.

A consultation has now begun on the recommendations contained in the guidance.

Deborah Alsina MBE, Chief Executive of Bowel Cancer UK said: “We are extremely pleased that Lynch syndrome is being recognised in NICE’s bowel cancer guidance for the first time, along with the recommendation of aspirin to prevent bowel cancer for people with the genetic condition. Lynch syndrome can increase the lifetime risk of bowel cancer to up to 80%, so finding more ways to prevent the disease is crucial.

There is evidence to show that long term aspirin use can reduce the risk of bowel cancer in people with Lynch syndrome. CAPP 2, a randomised control trial including patients across multiple countries, found a protective effect in those taking 600mg of aspirin every day for just over two years.

However, taking aspirin can have serious side effects in some people, so it’s important to find the optimal dose that weighs up the benefits and harms of taking the drug long term. We don’t yet know enough about which dose should be prescribed for people with Lynch syndrome, but the CAPP 3 trial is comparing what works best – 100mg, 300mg or 600mg of daily aspirin. Anyone thinking about taking aspirin over a longer period of time should always speak to their GP first.

“With an estimated 200,000 people in the UK with Lynch syndrome, improvements to their management and surveillance is a step in the right direction. However, for initiatives like this to have any affect, it is crucial that identification is addressed by putting guidance on Lynch syndrome testing into practice. Currently, 95% of people do not know that they have Lynch syndrome. This is unacceptable.

In June, Wales became the first UK nation to introduce universal testing of Lynch syndrome for all those diagnosed with bowel cancer. It is vital that the governments of Scotland, England and Northern Ireland follow Wales' example and fully commit to a national system of testing for Lynch syndrome. Until this happens, generations of families will be devastated by bowel cancer and lives will be needlessly lost to a disease that is treatable and curable.”

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