The compelling journey of colorectal cancer prevention by aspirin | Professor Finlay Macrae

From case-control studies to the 20 year follow up of the CaPP2 RCT.

2 September 2020

Head, Colorectal Medicine and Genetics
The Royal Melbourne Hospital

Since the initial observations by Prof Gabriel Kune in Melbourne, the ability of aspirin to prevent colorectal cancer has been a compelling story supported by hundreds of case control and cohort studies, post hoc evaluations of RCTs in cardiovascular disease prevention, and more recently targeted randomised controlled trials.

This cheap intervention has an effect size equal to colonoscopy, at least in Lynch Syndrome, and an extraordinary duration effect of 20 years. The clinical studies have lead attempts to explore mechanisms, which are still uncertain. Dose also remains uncertain, but effect is certain. Australia leads the world in advocating population based recommendations. Caution in the elderly has been introduced by the Monash ASPREE studies.

Professor Finlay Macrae AO has had a career long engagement in clinical studies of prevention of bowel cancer. Aspirin is a major part of this, leading the Australian CaPP2 and CaPP3 studies of aspirin in Lynch Syndrome in collaboration with Sir John Burn’s trials in UK. His earlier work established the foundations of the National Bowel Cancer Screening Program in Australia and contributed precision to the Australian NHMRC guidelines for prevention of colorectal neoplasia.