Familial Cancer

, Volume 16, Issue 1, pp 99–109 | Cite as

Exploring clinicians’ attitudes about using aspirin for risk reduction in people with Lynch Syndrome with no personal diagnosis of colorectal cancer

  • Yanni Chen
  • Michelle Peate
  • Rajneesh Kaur
  • Bettina Meiser
  • Tim Wong
  • Judy Kirk
  • Robyn L. Ward
  • Annabel Goodwin
  • Finlay Macrae
  • Janet Hiller
  • Alison H. Trainer
  • Gillian Mitchell
Original Article


Recent research has shown that aspirin reduces the risk of cancers associated with Lynch Syndrome. However, uncertainty exists around the optimal dosage, treatment duration and whether the benefits of aspirin as a risk-reducing medication (RRM) outweigh adverse medication related side-effects. Little is known about clinicians’ attitudes, current practice, and perceived barriers to recommending aspirin as a RRM. To explore the attitudes of clinicians who discuss risk management options with patients with Lynch Syndrome towards using aspirin as a RRM. Clinicians were invited through professional organisations to complete an online survey. Topics included their clinical experience with Lynch Syndrome, views and practice of recommending aspirin as a RRM, and knowledge about clinical risk management guidelines for Lynch Syndrome. Comparison of attitudes was made between three professional groups. 181 respondents were included in the analysis: 59 genetics professionals (genetic counsellors and clinical geneticists, medical oncologists with specialist training in familial cancer), 49 gastroenterologists and 73 colorectal surgeons. Most clinicians (76 %) considered aspirin to be an effective RRM and most (72 %) were confident about discussing it. In all professional categories, those who were confident about discussing aspirin with patients perceived it to be an effective RRM (OR = 2.8 [95 % CI = 1.8–4.2], p < 0.001). Eighty percent (47/59) of genetics professionals reported having discussed the use of aspirin with Lynch Syndrome patients compared to 69 % of gastroenterologists and 68 % of colorectal surgeons. Those who considered aspirin as an effective RRM or who felt confident in their knowledge of the aspirin literature were more likely (OR = 10 [95 % CI = 1.5–65], p = 0.010, OR = 6 [95 % CI = 2.2–16], p < 0.001, respectively) to discuss it with their patients than other professionals in the study. Similarly health professionals who felt confident in their knowledge of literature of aspirin/confident in discussing with the patients were more likely (OR = 6 [95 % CI = 2.2–16], p < 0.001) to discuss with their patients. Health professionals who saw more than ten patients with Lynch Syndrome per year were more likely to be confident in their knowledge of the aspirin literature and discussing it with patients (OR = 4.1 [95 % CI = 1.6–10.2], p = 0.003). Explicit recommendations to take aspirin, was reported by 65/83 (78 %) of health professionals. Eighty-seven percent of health professionals reported a need for patient educational materials about aspirin. Continuing training is needed to increase clinicians’ confidence in their knowledge of the literature on the use of aspirin as a RRM. Patient education materials may be helpful in improving consistency in patient care and facilitate communication between clinicians and people living with Lynch Syndrome.


Aspirin Clinicians’ attitudes Colorectal cancer Colorectal surgeons Gastroenterologist Genetics professionals Lynch Syndrome Personal diagnosis Risk-reduction medication 



This work is carried out with support from the University of New South Wales and the Inherited Cancer Connect (ICCon) Partnership. The ICCon Partnership is funded by the Cancer Council New South Wales Strategic Research Partnership (STREP) scheme. The authors would like to extend their gratitude to the participants involved in this research, directors of the familial cancer clinics in Australia and the professional organisations (COSA, CSSANZ, CNSA and GESA) who sent out the invitation emails. Michelle Peate is supported by a National Breast Cancer Foundation Early Career Fellowship (ECF-15-005).


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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Yanni Chen
    • 1
    • 2
  • Michelle Peate
    • 3
    • 4
  • Rajneesh Kaur
    • 3
  • Bettina Meiser
    • 3
  • Tim Wong
    • 5
  • Judy Kirk
    • 6
    • 7
  • Robyn L. Ward
    • 8
  • Annabel Goodwin
    • 9
  • Finlay Macrae
    • 10
  • Janet Hiller
    • 11
  • Alison H. Trainer
    • 12
  • Gillian Mitchell
    • 12
    • 13
  1. 1.Sydney Medical School – Northern, Kolling Institute Level 7, Royal North Shore HospitalUniversity of SydneySydneyAustralia
  2. 2.Department of Psychosocial OncologyNational Cancer CentreSingaporeSingapore
  3. 3.Psychosocial Research Group, Lowy Cancer Research Centre C25, Prince of Wales Clinical SchoolUniversity of New South WalesSydneyAustralia
  4. 4.Department of Obstetrics and Gynaecology, Level 7, Royal Women’s HospitalUniversity of MelbourneParkvilleAustralia
  5. 5.School of Social SciencesUniversity of New South WalesSydneyAustralia
  6. 6.Westmead Institute for Cancer ResearchWestmead Millennium InstituteSydneyAustralia
  7. 7.Familial Cancer ServiceWestmead HospitalSydneyAustralia
  8. 8.University of QueenslandBrisbaneAustralia
  9. 9.Medical OncologyConcord Cancer CentreSydneyAustralia
  10. 10.Colorectal Medicine and Genetics and University Dept of MedicineRoyal Melbourne HospitalMelbourneAustralia
  11. 11.School of Health SciencesSwinburne University of TechnologyMelbourneAustralia
  12. 12.Familial Cancer CentrePeter MacCallum Cancer CentreMelbourneAustralia
  13. 13.Sir Peter MacCallum Deparment of OncologyUniversity of MelbourneMelbourneAustralia

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