A cheap, familiar pill just delivered eye-popping results in a rigorous cancer trial. Researchers in Sweden report that taking a low daily dose of aspirin after surgery cut the risk of colorectal cancer returning by about half — but only in patients whose tumors carry specific PI3K-pathway gene alterations.
The multicountry ALASCCA study, led by teams at Karolinska Institutet and Karolinska University Hospital, followed more than 3,500 people treated for colon or rectal cancer at 33 hospitals in Sweden, Norway, Denmark and Finland. Everyone had their primary tumor removed. Genetic testing then flagged a large subgroup — roughly a third of patients — with alterations in the PI3K pathway, including PIK3CA “hotspot” mutations long suspected to drive growth and spread in colorectal tumors.
Those patients were randomly assigned to swallow 160 mg of aspirin once a day or a placebo for three years. When researchers checked back, the aspirin group had a 55% lower risk of recurrence than those on placebo. The effect appeared even stronger in women, a signal the team says needs more study. Results were published in the New England Journal of Medicine and described by senior author Prof. Anna Martling as the first randomized proof that low-dose aspirin can meaningfully reduce relapse in genetically defined colorectal cancer.
The finding turns a century-old painkiller into a precision-medicine tool. Biologically, it makes sense: aspirin dampens inflammation, blunts platelet activity that can shield circulating tumor cells, and seems to interfere with the PI3K signaling that fuels malignant growth. Outside experts noted the consistency with earlier observational work — including data in Lynch syndrome — but welcomed the randomized design here. As Fox News medical contributor Dr. Marc Siegel put it, regular NSAID use has been linked to lower colon cancer risk for years; this trial shows a targeted group may benefit after surgery, too.
No drug is risk-free, and the researchers are the first to say so. A handful of patients experienced serious side effects possibly tied to aspirin, including gastrointestinal bleeding and a rare brain bleed, and one death was deemed possibly related. People with active ulcers, bleeding disorders or aspirin-sensitive asthma shouldn’t take it, and anyone on other blood thinners or drinking heavily needs careful counseling. The trial also excluded patients over 80, wasn’t designed to slice the data into many subgroups, and will need longer follow-up to show whether the recurrence drop translates into better overall survival.
What is immediately actionable is the testing. Because the benefit was confined to tumors with PI3K-pathway alterations, the authors argue that every resected colorectal cancer should be screened soon after surgery. If that alteration is present, a doctor-supervised course of daily low-dose aspirin could be considered as part of the adjuvant plan. If it’s absent, aspirin hasn’t shown the same payoff and still carries bleeding risk. That “test-then-treat” approach is exactly the kind of cost-conscious personalization oncology has been chasing, especially with a pill that’s globally available and far cheaper than many modern cancer drugs.
Colorectal cancer remains one of the world’s most common malignancies, with nearly two million diagnoses a year and stubborn relapse rates even after seemingly successful surgery. Against that backdrop, an inexpensive therapy that could prevent thousands of recurrences annually would be a genuine win — particularly in places where access to high-priced novel agents is limited.
For patients and families eager to act, one note of caution: this isn’t a do-it-yourself regimen. Talk to your oncology team about tumor genetic testing, your personal bleeding risk, other medications, and whether you fit the profile that benefited in the trial. The promise here is big, but it hinges on the right mutation, the right dose, and the right medical supervision.
FOX News, the Guardian, and the Independent contributed to this report.
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