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Inherited bowel cancer risk reduced by aspirin

Aspirin can more than halve bowel cancer risk in obese people with Lynch syndrome – an inherited condition linked to an increased risk of cancer – according to data from a UK clinical trial.

The new analysis of the CAPP2 trial, reported by Cancer Research UK, showed that obesity heightened the risk of bowel cancer among people with the condition, who already have a much higher risk of bowel and other cancers than the general population.

However, the effect was observed most clearly in people with a body mass index (BMI) over 30, and in men. The effect also seemed to differ depending on the precise genetic cause of Lynch syndrome, which is caused by inherited faults in one of four genes, all of which are involved in repairing damaged DNA. Obesity increased the risk for people with faults in a gene called MLH1, yet the same effect was not seen in those carrying with errors in a different gene, MSH2.

The findings, published in the Journal of Clinical Oncology also suggest that this increased risk in overweight and obese people can be reduced by regular aspirin.

According to Professor Matthew Seymour, a bowel cancer expert at Cancer Research UK – which helped fund the study – the discovery built on previous analysis from the trial. “CAPP2 has already produced valuable information, showing that for people with an inherited tendency to develop bowel cancer, their risk can be reduced by taking aspirin. Now this additional analysis from the same clinical trial shows that avoiding becoming obese may be especially important for people with this inherited condition.”

The researchers, based at Newcastle University and the University of Leeds, gave 937 patients with Lynch Syndrome either 600mg aspirin, or a placebo, every day for an average of two years. After an average of nearly five years, 55 of them had developed bowel cancer. Those taking placebos were almost three (2.75) times more likely to develop bowel cancer during this period, while those who were overweight or obese in the aspirin group had the same risk as those who had a normal weight.

“This information is helpful for advising people with an inherited risk of bowel cancer,” said Seymour. “But it’s also important as it gives new clues about the mechanisms which may underly the rising incidence of bowel cancer in the general population, and provides important new leads for scientists working to understanding what triggers this disease and how to combat it,” he added.

Vicki Kiesel, Genetic Director of GeneHealth UK and a registered genetic counsellor working within the NHS, explains: “As with all diseases, prevention is preferable to cure, but the key to this is the patient understanding their individual risk, how their genes may impact upon it, and which problematic genes – if any – they actually carry. This is where genetic testing and genetic counselling can play a vital role. It cannot be stressed enough how important it is that testing and genetic counselling are delivered together – testing can tell patients what gene mutations are present, but gene counselling is where the full significance of this data is explained and explored. At the moment, breast cancer and the presence of the BRCA1/BRCA2 gene mutations are the examples that are most well-known inherited cancer conditions, but awareness is increasing in all areas of cancer genetics. Anything that can be done to help people manage their own cancer risk – including better understanding of a faulty MLH1 gene – is to be welcomed.”

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