{"entity":{"id":"aspirin-cancer-prevention","kind":"technology","name":"Aspirin for cancer prevention and adjuvant therapy","aka":[],"tldr":"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.","summary":"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.","status":"phase-3","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Aspirin#Cancer_prevention","links":[{"label":"ALASCCA (NEJM 2025)","url":"https://doi.org/10.1056/NEJMoa2504650"},{"label":"CAPP2 10-year follow-up (Lancet 2020)","url":"https://doi.org/10.1016/S0140-6736(20)30366-4"},{"label":"ASPREE cancer outcomes (NEJM 2018)","url":"https://doi.org/10.1056/NEJMoa1803955"},{"label":"Burn, Lancet 2020: CAPP2, cancer prevention with aspirin in Lynch syndrome, 10-year follow-up (861 patients randomised)","url":"https://doi.org/10.1016/s0140-6736(20)30366-4"},{"label":"NICE NG151: colorectal cancer, recommendations (Lynch 1.1, local disease 1.3, biomarkers 1.4, metastatic disease 1.5, ongoing care and support including follow-up 1.6)","url":"https://www.nice.org.uk/guidance/ng151/chapter/Recommendations"},{"label":"CRUK: bowel cancer risk factors (professional)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/risk-factors"}],"tags":[],"related":["lynch-syndrome","idea-reg-aspirin-pik3ca-implementation","idea-prev-lynch-aspirin-implementation","idea-bio2-platelet-cloak-aspirin-mrd"],"cancers":["colorectal","esophageal","gastric","breast-hr-positive","prostate","lynch-associated-colorectal-cancer"],"sections":["nutrition-lifestyle","prevention"],"technologies":["chemoprevention","drug-repurposing"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":["pi3k-akt-mtor"],"terms":["germline-vs-somatic","lynch-syndrome"],"trials":["alascca","add-aspirin","aspree"],"people":[],"bottlenecks":["b-generic-repurposing","b-funding-allocation"],"keyPapers":["paper-mcneil-n-engl-j-med"],"journals":[],"dependsOn":[],"notes":["The randomised result in inherited risk: in CAPP2, 861 people with Lynch syndrome were randomised to 600 mg of aspirin daily or placebo and followed for a mean of ten years; colorectal cancer occurred in 9 percent of the aspirin group against 13 percent of the placebo group (hazard ratio 0.65 by intention to treat, 0.56 in the 509 who completed two years of treatment), with no difference in adverse events during the intervention (Burn 2020). NICE NG151 (1.1.1) says to consider daily aspirin for more than two years in Lynch syndrome, an off-label use in January 2020.","In the general population, bowel cancer risk is 17 percent lower in people who have ever used aspirin than in non-users, and lower the longer the use (meta-analysis of cohort studies, Cancer Research UK)."],"principle":"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.","strengths":["Randomised evidence in Lynch syndrome and PIK3CA-altered colorectal cancer","Pennies per day, universally available","Biomarker allows targeting"],"limitations":["Bleeding harm and excess cancer deaths in older unselected adults","Effect emerges only after years","Implementation of ALASCCA requires routine PIK3CA testing"]},"route":"/technologies/aspirin-cancer-prevention/","neighbours":{"term":[{"id":"germline-vs-somatic","kind":"term","name":"Germline vs somatic mutations","route":"/terms/germline-vs-somatic/"},{"id":"inflammation","kind":"term","name":"Inflammation","route":"/terms/inflammation/"},{"id":"lynch-syndrome","kind":"term","name":"Lynch syndrome","route":"/terms/lynch-syndrome/"},{"id":"microenvironment-inflammation-theory","kind":"term","name":"Microenvironment and inflammation: tumours as wounds that do not heal","route":"/terms/microenvironment-inflammation-theory/"}],"idea":[{"id":"idea-reg-aspirin-pik3ca-implementation","kind":"idea","name":"Get biomarker-directed aspirin after colorectal surgery into labels and guidelines","route":"/ideas/idea-reg-aspirin-pik3ca-implementation/"},{"id":"idea-prev-lynch-aspirin-implementation","kind":"idea","name":"Get every Lynch syndrome carrier onto the right dose of aspirin","route":"/ideas/idea-prev-lynch-aspirin-implementation/"},{"id":"idea-bio2-platelet-cloak-aspirin-mrd","kind":"idea","name":"Strip the platelet coat off travelling tumour cells in ctDNA-positive patients","route":"/ideas/idea-bio2-platelet-cloak-aspirin-mrd/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"gastric","kind":"cancer","name":"Gastric & gastro-oesophageal junction cancer","route":"/cancers/gastric/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"lynch-associated-colorectal-cancer","kind":"cancer","name":"Lynch syndrome-associated colorectal cancer","route":"/cancers/lynch-associated-colorectal-cancer/"},{"id":"esophageal","kind":"cancer","name":"Oesophageal cancer","route":"/cancers/esophageal/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"},{"id":"prevention","kind":"section","name":"Prevention & Risk","route":"/fronts/prevention/"}],"technology":[{"id":"chemoprevention","kind":"technology","name":"Chemoprevention & risk-reducing surgery","route":"/technologies/chemoprevention/"},{"id":"drug-repurposing","kind":"technology","name":"Systematic drug repurposing","route":"/technologies/drug-repurposing/"}],"pathway":[{"id":"intravasation-ctc-survival","kind":"pathway","name":"Intravasation & circulating tumour cells","route":"/pathways/intravasation-ctc-survival/"},{"id":"mismatch-repair-msi","kind":"pathway","name":"Mismatch repair & microsatellite instability","route":"/pathways/mismatch-repair-msi/"},{"id":"pi3k-akt-mtor","kind":"pathway","name":"PI3K / AKT / mTOR","route":"/pathways/pi3k-akt-mtor/"}],"trial":[{"id":"add-aspirin","kind":"trial","name":"Add-Aspirin","route":"/trials/add-aspirin/"},{"id":"alascca","kind":"trial","name":"ALASCCA","route":"/trials/alascca/"},{"id":"aspree","kind":"trial","name":"ASPREE (ASPirin in Reducing Events in the Elderly)","route":"/trials/aspree/"},{"id":"capp2","kind":"trial","name":"CAPP2","route":"/trials/capp2/"}],"bottleneck":[{"id":"b-funding-allocation","kind":"bottleneck","name":"Funding follows fashion, not burden","route":"/bottlenecks/b-funding-allocation/"},{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"}],"paper":[{"id":"paper-balkwill-mantovani-inflammation-virchow-lancet-2001","kind":"paper","name":"Balkwill and Mantovani 2001: inflammation and cancer, back to Virchow?","route":"/key-papers/paper-balkwill-mantovani-inflammation-virchow-lancet-2001/"},{"id":"paper-mcneil-n-engl-j-med","kind":"paper","name":"Effect of Aspirin on All-Cause Mortality in the Healthy Elderly","route":"/key-papers/paper-mcneil-n-engl-j-med/"},{"id":"paper-grivennikov-immunity-inflammation-cancer-cell-2010","kind":"paper","name":"Grivennikov, Greten and Karin 2010: immunity, inflammation and cancer","route":"/key-papers/paper-grivennikov-immunity-inflammation-cancer-cell-2010/"}],"roadmap":[{"id":"prevention-roadmap","kind":"roadmap","name":"Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers","route":"/roadmaps/prevention-roadmap/"}]}}