# Get every Lynch syndrome carrier onto the right dose of aspirin

Source: https://onco.cc/ideas/idea-prev-lynch-aspirin-implementation/  
OnCo record `idea-prev-lynch-aspirin-implementation` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

Aspirin roughly halves bowel cancer in Lynch syndrome, as CAPP2 showed with 600 mg, and CaPP3 is comparing 100, 300 and 600 mg, yet most carriers are still not prescribed it. This idea is an implementation programme: guideline update, an automatic recommendation at diagnosis and registry tracking of prescription and adherence, so that nearly every carrier is on the right dose within three years. The evidence exists; the gap is practice. The test is a registry-based before-and-after study with regional stepped rollout. Being tested at scale, it addresses the bottlenecks Inherited risk is mostly unidentified and Prevention we already have is not deployed, and links to aspirin for cancer prevention.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- 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.
- Proposed test: Run a registry-based before/after study with regional stepped rollout.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- Bottleneck evidence (Inherited risk is mostly unidentified): Childers et al., National estimates of genetic testing in women with breast or ovarian cancer (JCO 2017): https://doi.org/10.1200/JCO.2017.73.6314

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Mismatch-repair deficient (MSI-high) colorectal cancer](https://onco.cc/cancers/msi-high-colorectal/)
- fronts: [Prevention & Risk](https://onco.cc/fronts/prevention/)
- technologies: [Aspirin for cancer prevention and adjuvant therapy](https://onco.cc/technologies/aspirin-cancer-prevention/), [Chemoprevention & risk-reducing surgery](https://onco.cc/technologies/chemoprevention/)
- terms: [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/)
- bottlenecks: [Inherited risk is mostly unidentified](https://onco.cc/bottlenecks/b-hereditary-risk/), [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/)
- key papers: [CAPP2: two years of aspirin cuts bowel cancer in Lynch syndrome by more than a third over 10 years](https://onco.cc/key-papers/paper-capp2-aspirin-lynch-lancet-2020/), [National Estimates of Genetic Testing in Women With a History of Breast or Ovarian Cancer](https://onco.cc/key-papers/paper-childers-j-clin-oncol/)
- roadmaps: [Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers](https://onco.cc/roadmaps/prevention-roadmap/)

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