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Persistence paid off: a bowel cancer breakthrough

Monday 24 August, 2020
Please note: It's important that you speak with your doctor before taking aspirin to make sure it's right for you.


After chipping away at an idea through decades of groundwork, a dedicated Victorian cancer researcher has delivered a remarkable breakthrough discovery for preventing bowel cancer.

Professor Finlay and his international colleagues have discovered the next piece of the puzzle – for people aged between 50 to 70 years of age, taking a low dose of aspirin daily can help significantly reduce your risk of developing bowel cancer.

This wonderful achievement has been made possible, in part, thanks to generosity like yours. Over the years, many of Professor Macrae’s research projects have been funded through Cancer Council Victoria.

And with each research project expanding on knowledge from those that came before it, the researcher’s cumulative learnings have made this important discovery possible.

Professor Macrae, Head of Colorectal Medicine and Genetics at The Royal Melbourne Hospital, says the findings are an important step forward in our understanding of the role of aspirin as a preventative medicine.

"The evidence linking aspirin and a lower cancer risk has been accumulating for a long time," Professor Macrae said.

"Previous, shorter trials have not been able to prove this link as the positive benefits of aspirin are not seen immediately," he said, "this can take some years, even decades."

The international clinical trial randomly assigned 937 eligible participants with the genetic condition Lynch syndrome – a disorder which puts them at a higher risk of developing bowel cancer – to either 600mg aspirin or placebo tablets. This higher risk offered the best chance of seeing an effect of aspirin.

The randomly assigned participants took either aspirin or a placebo for an average of 2.5–5 years – but the recent Lancet paper reports the remarkable results 20 years after the trial began.

The study enlisted participants from all around the world – including Europe, Australasia, Africa and America.

Prof Finlay Macrae

Professor Finlay Macrae

Professor Macrae points to the situation as “like canaries in a coal mine” from which we can take note of the effects of an intervention (in this case, aspirin) for them and, possibly the rest of us, with respect to factors that might increase or decrease risk.

The protective effect is supported by many observational studies across a wide range of people, mostly at average risk. Government bowel cancer prevention guidelines now recommend that all Australians 50 to 70 years of age speak with their doctor about whether taking low dose aspirin daily (100-300mg) for cancer prevention is appropriate, as some existing medical conditions prohibit its use. It’s also important to note that taking daily low dose aspirin may not be suitable for people aged over 70.

The road to discovery

Professor Finlay Macrae has dedicated his career to researching ways we can reduce our risk of bowel cancer – Australia’s second biggest cancer killer.

In the late 1970s and early 1980s, Cancer Council Victoria funded several of Professor Macrae’s studies on the early detection of colorectal cancer – including dietary trials of low fat and fibre – that now are framed in the NHMRC dietary guidelines for prevention of bowel cancer.

Through his early studies, he contributed extensive knowledge on screening for bowel cancer, documenting patterns of quantitative bleeding from bowel cancers and adenomas.

This work supported the establishment of the National Bowel Cancer Screening Program – where all Australians between the ages of 50 and 74 are sent a free, simple bowel screening test in the mail to complete at home.

This approach has been replicated in many countries around the world.

How you can manage your bowel cancer risk

Healthy lifestyle

The best thing you can do to reduce your risk of bowel cancer is maintain a healthy lifestyle – which includes eating well, not smoking and being physically active.

Complete the home bowel screening test

For those aged 50 to 74 years, completing the at home bowel screening kit every two years could save your life.

Around 15,000 Australians will develop bowel cancer each year, and unfortunately, many of them will have no symptoms until the cancer is in its final stages – where survival rates fall to below 15%.

A scene from our television ad as part of the National Bowel Screening Campaign.

But still, many people leave their free bowel screening kit in the cupboard and never complete the test, and miss out on the chance to catch bowel cancer early.

With your support, in 2017 we encouraged eligible Australians to do the simple and easy test with our National Bowel Screening Campaign.

It resulted in approximately 12,500 extra Victorians screening for bowel cancer during the campaign period – saving more than 300 people from developing bowel cancer and more than 180 from dying of bowel cancer.

Talk to your doctor

And finally, before rushing out to the pharmacy to start taking low dose aspirin daily, Professor Macrae urges all people within the relevant age group to discuss taking it with their doctor. If government restrictions or health complications are making it difficult to visit your doctor, why not try telehealth?

“Unless you have an active ulcer or indigestion, uncontrolled high blood pressure, kidney impairment or an aspirin allergy, all Australians 50 to 70 years should seriously consider taking 100mg of aspirin daily” – Professor Macrae.

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