OnCo
ideasIdea

Get every Lynch syndrome carrier onto the right dose of aspirin

Aspirin roughly halves bowel cancer in Lynch syndrome, and a dose trial is defining how little is needed. Most carriers are still not prescribed it; the task is to fix prescribing.

CAPP2 showed about a 50% reduction in colorectal cancer with 600 mg aspirin; CaPP3 compares 100, 300 and 600 mg. Propose an implementation programme: guideline update, automatic recommendation at diagnosis, and registry tracking of prescription and adherence.

Hypothesis
Implementation raises aspirin use among Lynch carriers from under 40% to at least 80% within three years.
Rationale
The evidence exists; the gap is practice.
What would test it
Run a registry-based before/after study with regional stepped rollout.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
3
Bottlenecks it attacks

Key papers

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rctThe Lancet 2020changed practice
CAPP2: two years of aspirin cuts bowel cancer in Lynch syndrome by more than a third over 10 years

People with Lynch syndrome should be offered daily aspirin, which roughly halves bowel cancer risk with a delayed and durable effect. Whether a lower dose (as tested in CAPP3) is as effective, and whether the finding extends to the general population, are separate questions.

Connected

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Pages like this

not linked directly; found by shared links

cancers

1
Colorectal cancer

fronts

1
Prevention & Risk

technologies

2
Aspirin for cancer prevention and adjuvant therapyChemoprevention & risk-reducing surgery

terms

1
Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)

bottlenecks

2
Inherited risk is mostly unidentifiedPrevention we already have is not deployed

key papers

1
CAPP2: two years of aspirin cuts bowel cancer in Lynch syndrome by more than a third over 10 years