Background: Patients with Lynch syndrome have up to 80% lifetime risk of developing colorectal cancer. Research shows chemoprevention with aspirin 600 mg for 25 months can reduce this risk for Lynch syndrome patients by 59%. In our study, we evaluated the compliance with aspirin therapy among Lynch patients at our institution. Methods: Our clinic identifies and follows all patients with a history of Lynch syndrome. Of our 125 patients, 62% were discovered after a family member was found to have a high-risk cancer, 29% were identified through MyCode, a DNA sequencing program which looks for gene mutations specific to Lynch. All patients in the clinic undergo discussion about starting aspirin therapy. Medication agreements and dosing are documented in the chart. Data was retrospectively reviewed to assess our patient compliance with recommendations. All data was based on subjective reports of compliance and reported doses. Results: 125 patients were included in the data analysis. Various risk factors were assessed including age, gender, history of cancer, and other comorbidities. Ages ranged from 20 to 78; 74% were female, 26% male. 90% of patients had a family cancer and of those, 47% had a personal history of cancer. Overall, 57% of patients agreed to take aspirin with doses ranging between 81 mg to 600 mg. 60.8% of patients took 81 mg of aspirin daily and 30.6% took 325 mg daily, citing concerns for bleeding and ulcer at higher doses. Only 8% of all patients agreeable to aspirin therapy took the recommended 600 mg dose. Of those who refused aspirin therapy, 5% reported allergy or prior intolerance, 13% had history of gastric ulcer or prior bleeding, 2% were taking medications which taken concomitantly with aspirin would increase risk of bleeding, and 80% provided no reason. Chi square test of independence was performed to examine the relationship between aspirin use and gender (χ² = 0.76, p = 0.38), age (χ² = 1.99, p = 0.37), and personal or family history of cancer (χ² = 9.89, p = .002). Results showed a patient with personal, or family history of cancer was more likely to take aspirin therapy, but there was no significant relationship among gender or age. Conclusions: Aspirin serves as an effective and affordable therapy for the prevention of colorectal cancer in patients with Lynch syndrome. Barriers to compliance should be identified and chemoprophylaxis should be initiated in all qualified patients. Future studies should be performed to establish more concrete recommendations about dosing and duration of aspirin therapy especially given the ease of access and cost effectiveness.