Offer daily aspirin to those with inherited genetic condition to reduce the risk of colorectal cancer

Aspirin taken daily for 2 years or more could reduce the risk of colorectal cancer in people with Lynch syndrome (LS), says NICE in new draft updated guidance.

 

People with LS have an increased lifetime risk – estimated to be four out of five people – of developing colorectal cancer.

Regular screening with colonoscopy and polypectomy to identify pre-cancerous cells has until now been the main strategy to detect early colorectal cancer in people with LS and offer appropriate management.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, said: “The independent committee looked at evidence from a multi-country randomised controlled trial, which showed taking daily aspirin for more than two years reduces the risk of colorectal cancer in people with Lynch syndrome.

“While there are risks associated with long-term aspirin use, the committee agreed that the benefits are likely to outweigh any potential harms.

"It is important that clinicians and patients discuss the potential harms and benefits of long-term aspirin use so that an informed decision can be made."

An estimated 175,000 people in the UK have LS, a large proportion of whom will be unaware that they have the condition.

NICE published diagnostics guidance in 2017 recommending that everyone who is diagnosed with colorectal cancer should be tested for LS.  If the test shows they do have LS, they can be monitored for other cancers and their close relatives can also be offered testing for LS. Updated guidance recommends aspirin is an option to reduce the risk of colorectal cancer among this group.

Colorectal cancer (cancer of the colon or rectum, or bowel) is the fourth most common form of the disease in the UK, with more than 42,000 new cases diagnosed each year according to Bowel Cancer UK. However it is the UK’s second biggest cancer killer, with 44 people dying each day.

When published the updated guideline will replace NICE’s existing guideline on the diagnosis and management of colorectal cancer.

It is important that clinicians and patients discuss the potential harms and benefits of long-term aspirin use so that an informed decision can be made.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE