Re: Aspirin and cancer prevention
While Kurth urges caution in recommending aspirin as a chemopreventive for the general population, one must also note that he accepts that there is a compelling case for aspirin as a prophylactic for specific subgroups . One such subgroup ought to be those suffering from Li Fraumeni Syndrome (LFS) and other TP53-related conditions.
LFS is a rare hereditary cancer syndrome characterised by germline mutations in the TP53 tumour suppressor gene. The syndrome is associated with a range of cancers, particularly sarcomas, leukemias, adrenocortical carcinomas and other malignancies, particularly during childhood and early adulthood. Among women with LFS, the most common disease is breast cancer, with a 49% risk of developing the disease by age 60 .
Clearly people with LFS are in urgent need of cancer-preventative options. Recent work suggests that aspirin has some anti-cancer activity against a range of cancer types in addition to its action against colorectal cancer [3, 4]. We note that the CaPP2 trial results showed a protective effect in the case of sufferers of Lynch Syndrome, a syndrome that predisposes to the development of colorectal cancer, but also showed some evidence of a protective effect in other cancers .
Given the high risk of developing cancer and the relatively low risk of adverse aspirin-related events, it is time to actively consider clinical trials in LFS patients to establish whether aspirin has a protective effect in this rare and life-threatening condition.
 Kurth K. Aspirin and cancer prevention, BMJ 2012;344:e2480 doi: 10.1136/bmj.e2480.
 Masciari et al. Breast cancer phenotype in women with TP53 germline mutations: a Li-Fraumeni syndrome consortium effort, Breast Cancer Res Treat 2012, doi: 10.1007/s10549-012-1993-9
 Mills et al. Low-dose Aspirin and Cancer Mortality: A Meta-analysis of Randomized Trials, Am J Med doi:10.1016/j.amjmed.2012.01.017
 Algra AM, Rothwell PM. Effects of regular aspirin on long-term cancer
incidence and metastasis: a systematic comparison of evidence from
observational studies versus randomised trials. Lancet Oncology 2012, DOI:10.1016/S1470-2045(12)70112-2.
 Burn et al. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial. Lancet 2012, doi:10.1016/S0140-6736(11)61049-0
Competing interests: No competing interests