Cancer prevention in the era of
precision medicine has to consider integrated therapeutic approaches. Therapeutic
cancer prevention should be offered to selected cohorts with increased
cancer risk. Undoubtedly, carriers of
hereditary cancer syndromes have a well-defined high
cancer risk.
Lynch Syndrome is one of the most frequent hereditary syndromes; it is mainly associated with
colorectal cancer (CRC). Nonsteroidal anti-inflammatory drugs and, in particular,
aspirin use, has been associated with reduced CRC risk in several studies, initially with contradictory results; however, longer follow-up confirmed a reduced CRC incidence and mortality. The CAPP2 study recruited 861
Lynch syndrome participants randomly assigned to 600 mg of
aspirin versus placebo. Like sporadic
CRCs, a significant CRC risk reduction was seen after an extended follow-up, with a median treatment time that was relatively short (2 years). The ongoing CAPP3 will address whether lower doses are equally effective. Based on pharmacology and clinical data on sporadic
CRCs, the preventive effect should also be obtained with low-dose
aspirin. The leading international guidelines suggest discussing with
Lynch syndrome carriers the possibility of using low-dose
aspirin for CRC prevention. We aim systematically promote this intervention with all
Lynch syndrome carriers.