Offer daily aspirin to cut risk of colorectal cancer in people with Lynch syndrome, says NICE

Lok, Pat; Dijk, Stijntje

doi:10.1136/bmj.l5010

Cited by 4 publications

(4 citation statements)

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“…The guidelines committee of NICE published draft guidance advising physicians that people with LS should be offered daily aspirin to reduce their risk of CRC [7]. The CaPP3 double-blind noninferiority phase III trial is now looking at the effects of three different doses of aspirin (600 mg, 300 mg, 100 mg) [37].…”

Section: Discussionmentioning

confidence: 99%

“…Depending on the affected gene, people with LS have a lifetime risk of CRC up to 50% and a younger age of onset [6]. Due to the high penetrance of this condition, people with LS may be advised to take a daily aspirin to reduce their risk of CRC, according to the recent draft guidance of the National Institute for Health and Care Excellence (NICE) [7]. The biological basis of this recommendation lies in the concept that cancer development in LS can be modulated by environmental factors, particularly those that influence inflammation [8].…”

Section: Introductionmentioning

confidence: 99%

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A Meta-Analysis of Obesity and Risk of Colorectal Cancer in Patients with Lynch Syndrome: The Impact of Sex and Genetics

et al. 2021

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There appears to be a sex-specific association between obesity and colorectal neoplasia in patients with Lynch Syndrome (LS). We meta-analyzed studies reporting on obesity and colorectal cancer (CRC) risk in LS patients to test whether obese subjects were at increased risk of cancer compared to those of normal weight. We explored also a possible sex-specific relationship between adiposity and CRC risk among patients with LS. The summary relative risk (SRR) and 95% confidence intervals (CI) were calculated through random effect models. We investigated the causes of between-study heterogeneity and assessed the presence of publication bias. We were able to retrieve suitable data from four independent studies. We found a twofold risk of CRC in obese men compared to nonobese men (SRR = 2.09; 95%CI: 1.23–3.55, I2 = 33%), and no indication of publication bias (p = 0.13). No significantly increased risk due to obesity was found for women. A 49% increased CRC risk for obesity was found for subjects with an MLH1 mutation (SRR = 1.49; 95%CI: 1.11–1.99, I2 = 0%). These results confirm the different effects of sex on obesity and CRC risk and also support the public measures to reduce overweight in people with LS, particularly for men.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Meta-Analysis of Obesity and Risk of Colorectal Cancer in Patients with Lynch Syndrome: The Impact of Sex and Genetics

et al. 2021

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“…Importantly, obesity exacerbates CRC risk in people with Lynch syndrome with the effect size being at least as great as that for sporadic CRC [ 41 ]. This is an important observation from the perspective of those with Lynch syndrome since it offers an opportunity to reduce cancer risk through improved lifestyle, in addition to the benefits from regular colonoscopy and use of aspirin [ 42 ].…”

Section: Cancermentioning

confidence: 99%

Translation of nutrigenomic research for personalised and precision nutrition for cancer prevention and for cancer survivors

Malcomson

Mathers

2023

Redox Biology

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“…Patients with LS and their high-risk relatives can benefit from intensive cancer surveillance, chemoprevention 4 , and risk-reducing surgeries 5 , particularly when they are identified sufficiently early.…”

Section: Introductionmentioning

confidence: 99%

Lynch syndrome pre-screening and comprehensive characterization in a multi-center large cohort of Chinese patients with colorectal cancer

Li¹,

Fan²,

Zheng³

et al. 2022

Cancer Biology & Medicine

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Objective: Lynch syndrome (LS) pre-screening methods remain under-investigated in colorectal cancers (CRCs) in Asia. Here, we aimed to systematically investigate LS pre-screening and comprehensively characterize LS CRCs. Methods: Microsatellite instability (MSI) and germline variants of DNA mismatch repair (MMR) genes were examined in 406 deficient MMR (dMMR) and 250 proficient MMR CRCs. The genetic differences between LS and sporadic CRCs were studied with whole exome sequencing analysis. Results: The incidence of dMMR in Chinese patients with CRCs was 13.8%. Consistency analysis between MMR immunohistochemistry (IHC) and MSI testing showed the kappa value was 0.758. With next-generation sequencing (NGS), germline variants were detected in 154 CRCs. Finally, 88 patients with CRC were identified as having LS by Sanger sequencing. Among them, we discovered 21 previously unreported pathogenic germline variants of MMR genes. Chinese patients with LS, compared with sporadic CRCs, tended to be early-onset, right-sided, early-stage and mucinous. Overall, the performance of MMR IHC and MSI testing for LS pre-screening was comparable: the area under the ROC curve for dMMR, MSI-H, and MSI-H/L was 0.725, 0.750, and 0.745, respectively. dMMR_MSI-H LS and sporadic CRCs showed substantial differences in somatic genetic characteristics, including different variant frequencies of APC, CREBBP, and KRAS, as well as different enriched pathways of VEGF, Notch, TGFβR, mTOR, ErbB, and Rac protein signal transduction. Conclusions: MMR IHC and MSI testing were effective methods for LS pre-screening. The revealed clinical and somatic genetic characteristics in LS CRCs may have the potential to improve the performance of LS pre-screening in combination with dMMR/MSI.

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Offer daily aspirin to cut risk of colorectal cancer in people with Lynch syndrome, says NICE

Cited by 4 publications

References 1 publication

A Meta-Analysis of Obesity and Risk of Colorectal Cancer in Patients with Lynch Syndrome: The Impact of Sex and Genetics

A Meta-Analysis of Obesity and Risk of Colorectal Cancer in Patients with Lynch Syndrome: The Impact of Sex and Genetics

Translation of nutrigenomic research for personalised and precision nutrition for cancer prevention and for cancer survivors

Lynch syndrome pre-screening and comprehensive characterization in a multi-center large cohort of Chinese patients with colorectal cancer

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