Aspirin for cancer prevention and adjuvant therapy
Daily low-dose aspirin lowers bowel cancer risk in people with Lynch syndrome and appears to cut recurrence in bowel cancers with a particular mutation. In healthy older people it caused more harm than good.
Long-term aspirin reduces colorectal cancer incidence and mortality in pooled analyses of cardiovascular trials with 20-year follow-up, and in CAPP2 halved colorectal cancer in Lynch syndrome carriers (600 mg/day, 10-year follow-up); the US Preventive Services Task Force nonetheless withdrew its general recommendation in 2022 because ASPREE (NEJM 2018) found more cancer deaths (HR 1.31) and no cancer prevention in healthy adults aged 70 and over. In the adjuvant setting the biomarker-directed ALASCCA trial (NEJM 2025) showed that 160 mg aspirin for three years roughly halved recurrence in resected colorectal cancer with PIK3CA or other PI3K-pathway alterations, and the 11,000-patient ADD-ASPIRIN trial across breast, colorectal, gastro-oesophageal and prostate cancers continues. Aspirin is the model repurposed generic: cheap, mechanistically plausible, and requiring publicly funded trials because no company will run them.
How it works
COX-1/COX-2 inhibition reduces prostaglandin E2-driven proliferation and inflammation and blunts platelet cloaking of circulating tumour cells; PI3K-pathway-mutant tumours depend on PTGS2 signalling and are selectively sensitive.
- Randomised evidence in Lynch syndrome and PIK3CA-altered colorectal cancer
- Pennies per day, universally available
- Biomarker allows targeting
- Bleeding harm and excess cancer deaths in older unselected adults
- Effect emerges only after years
- Implementation of ALASCCA requires routine PIK3CA testing
Latest papers
topQuery for this technology: (TITLE:"Aspirin for cancer prevention and adjuvant therapy" OR ABSTRACT:"Aspirin for cancer prevention and adjuvant therapy") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Aspirin for cancer prevention and adjuvant therapy, not a curated reading list.
Pages like this
not linked directly; found by shared links- Key paperCAPP2: two years of aspirin cuts bowel cancer in Lynch syndrome by more than a third over 10 years
Shares Get every Lynch syndrome carrier onto the right dose of aspirin, Get biomarker-directed aspirin after colorectal surgery into labels and guidelines, Lynch syndrome, Germline vs somatic mutations.
- TargetEpCAM
Shares Lynch syndrome, Intravasation & circulating tumour cells, Gastric & gastro-oesophageal junction cancer, Colorectal cancer.
- TechnologyVitamin D and omega-3 supplementation
Shares Chemoprevention & risk-reducing surgery, Oesophageal cancer, Gastric & gastro-oesophageal junction cancer, Prostate cancer.
- TechnologyFasting and fasting-mimicking diets around chemotherapy
Shares PI3K / AKT / mTOR, No incentive to repurpose cheap drugs, Funding follows fashion, not burden, HR-positive / HER2-negative breast cancer.
- IdeaPopulation germline screening for hereditary cancer genes with cascade testing
Shares Germline vs somatic mutations, Chemoprevention & risk-reducing surgery, HR-positive / HER2-negative breast cancer, Colorectal cancer.
- IdeaA public fund and label pathway to trial generic drugs against cancer
Shares No incentive to repurpose cheap drugs, Prostate cancer, HR-positive / HER2-negative breast cancer, Colorectal cancer.
- TargetWRN helicase (MSI-high cancers)
Shares Lynch syndrome, Mismatch repair & microsatellite instability, Gastric & gastro-oesophageal junction cancer, Colorectal cancer.
- IdeaA biomarker-directed trial of vitamin D after surgery for digestive tract cancers
Shares No incentive to repurpose cheap drugs, Oesophageal cancer, Gastric & gastro-oesophageal junction cancer, Colorectal cancer.