A1 Journal article (refereed)
Cancer Prevention with Resistant Starch in Lynch Syndrome Patients in the CAPP2-Randomized Placebo Controlled Trial : Planned 10-Year Follow-up (2022)

Mathers, J. C., Elliott, F., Macrae, F., Mecklin, J.-P., Möslein, G., McRonald, F. E., Bertario, L., Evans, D. G., Gerdes, A.-M., Ho, J. W. C., Lindblom, A., Morrison, P. J., Rashbass, J., Ramesar, R. S., Seppälä, T. T., Thomas, H. J. W., Sheth, H. J., Pylvänäinen, K., Reed, L., . . . Burn, J. (2022). Cancer Prevention with Resistant Starch in Lynch Syndrome Patients in the CAPP2-Randomized Placebo Controlled Trial : Planned 10-Year Follow-up. Cancer Prevention Research, 15(9), 623-634. https://doi.org/10.1158/1940-6207.CAPR-22-0044

JYU authors or editors

Publication details

All authors or editorsMathers, John C.; Elliott, Faye; Macrae, Finlay; Mecklin, Jukka-Pekka; Möslein, Gabriela; McRonald, Fiona E.; Bertario, Lucio; Evans, D. Gareth; Gerdes, Anne-Marie; Ho, Judy W. C.; et al.

Journal or seriesCancer Prevention Research



Publication year2022

Publication date25/07/2022


Issue number9

Pages range623-634

PublisherAmerican Association for Cancer Research (AACR)

Publication countryUnited States

Publication languageEnglish


Publication open accessOpenly available

Publication channel open accessPartially open access channel

Publication is parallel published (JYX)https://jyx.jyu.fi/handle/123456789/82568


The CAPP2 trial investigated the long-term effects of aspirin and resistant starch on cancer incidence in patients with Lynch syndrome (LS). Participants with LS were randomized double-blind to 30 g resistant starch (RS) daily or placebo for up to 4 years. We present long-term cancer outcomes based on the planned 10-year follow-up from recruitment, supplemented by National Cancer Registry data to 20 years in England, Wales, and Finland. Overall, 463 participants received RS and 455 participants received placebo. After up to 20 years follow-up, there was no difference in colorectal cancer incidence (n = 52 diagnosed with colorectal cancer among those randomized to RS against n = 53 on placebo) but fewer participants had non-colorectal LS cancers in those randomized to RS (n = 27) compared with placebo (n = 48); intention-to-treat (ITT) analysis [HR, 0.54; 95% confidence interval (CI), 0.33–0.86; P = 0.010]. In ITT analysis, allowing for multiple primary cancer diagnoses among participants by calculating incidence rate ratios (IRR) confirmed the protective effect of RS against non–colorectal cancer LS cancers (IRR, 0.52; 95% CI, 0.32–0.84; P = 0.0075). These effects are particularly pronounced for cancers of the upper GI tract; 5 diagnoses in those on RS versus 21 diagnoses on placebo. The reduction in non–colorectal cancer LS cancers was detectable in the first 10 years and continued in the next decade. For colorectal cancer, ITT analysis showed no effect of RS on colorectal cancer risk (HR, 0.92; 95% CI, 0.62–1.34; P = 0.63). There was no interaction between aspirin and RS treatments. In conclusion, 30 g daily RS appears to have a substantial protective effect against non–colorectal cancer cancers for patients with LS.

Prevention Relevance:
Regular bowel screening and aspirin reduce colorectal cancer among patients with LS but extracolonic cancers are difficult to detect and manage. This study suggests that RS reduces morbidity associated with extracolonic cancers.

Keywordscancerous diseasesLynch syndromecancer of the large intestineincidencepre-emptionstarchacetylsalicylic acidfollow-up study

Contributing organizations

Ministry reportingYes

Reporting Year2022

JUFO rating1

Last updated on 2024-15-06 at 23:05