posted on Tuesday, 11th August 2026
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It's been a long time since my last update but 2 years on from
the last CaPP3 participant reaching their fifth anniversary we have
now published the first results of our aspirin study. The take home
message is that the people who took 75mg aspirin were as well
protected as those who took 600mg and had fewer side effects. The
UK Cancer Genetics Group of the British Society for Genetic
Medicine support the recommendation that people with Lynch syndrome
should take a daily "baby aspirin".
We think that people carrying extra weight need a bigger dose.
We are recommending people with a BMI over 30 should take 150mg
(two baby aspirins) a day.
Side effects of aspirin increase as we get older. The protection
of taking aspirin last for several years after stopping. On balance
we think people should stop taking aspirin at 70 unless they need
it because of a risk of heart attacks.
Many people have a low grade infection in their stomach with a
bug called H pylori. It increases the risk of ulcers when you take
aspirin. A simple test can tell and antibiotics can clear the
infection.
Very rarely people have small swellings on blood vessels called
aneurysms. These can burst and if a person is taking aspirin they
bleed longer. This is a major problem if it happens inside the
brain. In most cases, high blood pressure causes aneurysms to leak
so we recommend that people about to take aspirin should have their
blood pressure checked and treated if needed.
With these precautions, the benefits for people with Lynch
syndrome are clear. We are working to get aspirin listed as in the
British National Formulary as a treatment for people with Lynch
syndrome. There are plans in England to write to all GPs with a
patient with Lynch syndrome in the next few months to tell them
about the new guidance.
Meanwhile we will continue to follow the records of all the
people in CaPP3 to collect a record of all cancers for at least 10
years from starting the aspirin. This will make the statistics more
certain and will give us the information we need to check how much
aspirin is needed for people carrying extra weight.
We are also working on a simple urine test to check if people
are taking enough aspirin. The urine test is looking at a chemical
that leaks from platelets. These are the small blood cells that fix
small leaks. They can also cause clots. Aspirin blocks platelets
and prevents clots. It also reduces the chemical, called
thromboxane, that we think prevents the immune system from
attacking cancer cells.
posted on Wednesday, 17th December 2025
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Today the "home team" had our last CaPP meeting before
submitting an amended version of the CaPP3 paper to Lancet
Gastroenterology and Hepatology for consideration for
publication. We originally submitted to Lancet who did not
feel the result was of sufficient general interest and offered
transfer to their specialist subsidiary journal which is,
nevertheless, a world leading journal with a very strong "impact
factor". We are working on our response to the referees'
comments and hope to see the primary report fully published in time
for the meeting in March in Singapore of the International Society
for Gastrointestinal Hereditary Tumours (InSiGHT) where I have the
honour of being an invited speaker.
Today was also an opportunity for Tim Bishop and Faye Elliott to
send their best wishes over Teams to Lynn Reed and Lynne Longstaff
who will be leaving us at the end of the month when the current
CaPP3 grant from Cancer Research UK comes to an end. Lynne
has been with the University for 40 years and became a member of
the CaPP team in 2014. Lynn joined the CaPP team 25 years
ago. They have been vital members of the international CaPP
community and will be greatly missed.
Tim Bishop and I will be leading another funding bid to Cancer
Research UK in the New Year to supplement the recent award by CRUK
of the SPARC programme (suppress platelet activation, reduce
cancer) which I co-lead with Ruth Langley from the MRC until 2029
and which will build on the CaPP biobank. More on this in the
New Year. Fin Macrae has also bid for funds to continue
support of the Australian follow up while we hope the teams in
Finland, Spain and Israel will continue to feed data into the new
REDCap database hosted by our hospital.
As most who read this are already aware, our conclusion from the
data gathered to date is that a "baby" aspirin is as effective at
preventing Lynch cancers as the 600mg dose used in CAPP2.
This involves some complex statistics and, as we predicted, it will
be necessary to continue our follow up to count cancers for a few
more years to finalise the proof. We are particularly
interested to check out the effect of having a higher body
weight. We think people who are significantly overweight will
need extra aspirin. The new guideline of the UK Cancer
Genetics Group will recommend 75mg daily in the UK and 150mg for
those with a BMI over 30. A series of international consensus
meetings of Lynch syndrome experts over the last couple of years
has agreed that people with Lynch syndrome should be advised to
take aspirin and recommends being guided on dose by the CaPP3
result.
New research has identified a chemical in the urine called
thromboxane which is released by platelets. In the
bloodstream, this chemical affects the body's defences against
cancer by making the white blood cells less powerful. Aspirin
suppresses the release of this chemical. In 2026 we will be
inviting all people who took part in CaPP3 to agree to collect a
urine sample at home and send this by mail to Newcastle to add to
our CaPP biobank. We can then begin to link the thromboxane
levels to future cancer risk. This could be a useful test in
the future to decide when to take aspirin and how much is
needed.
For now, thanks again to Lynn and Lynne for their many years of
service and Seasons Greetings to all who support our Cancer
Prevention Programme.
John Burn
An interview from the CGA conference in St Louis after I
presented the CaPP3 results:
https://www.youtube.com/watch?v=oexnbYBZrlw
Keynote Session - Should I Take an Aspirin? Aspirin
Chemoprevention in Lynch Syndrome - 2nd Annual Lynch
Syndrome Scientific Symposium, Daner-Farber Cancer Institute,
Boston:
https://www.youtube.com/watch?v=dwufGCxoPlQ&list=PLPLXayOtubE3TnXOKMLpNBa1CTAFLB06y&index=5