CaPPtain's Blog: John Burn, December 2025

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 - 2^nd Annual Lynch Syndrome Scientific Symposium, Daner-Farber Cancer Institute, Boston:
https://www.youtube.com/watch?v=dwufGCxoPlQ&list=PLPLXayOtubE3TnXOKMLpNBa1CTAFLB06y&index=5