title: Aspirin in the chemoprevention of colorectal neoplasia: an overview.
abstract: Considerable evidence supports the effectiveness of aspirin for chemoprevention of colorectal cancer (CRC) in addition to its well-established benefits in the prevention of vascular disease. Epidemiologic studies have consistently observed an inverse association between aspirin use and risk of CRC. A recent pooled analysis of a long-term posttrial follow-up of nearly 14,000 patients from four randomized, cardiovascular disease prevention trials showed that daily aspirin treatment for about five years was associated with a 34% reduction in 20-year CRC mortality. A separate metaanalysis of nearly 3,000 patients with a history of colorectal adenoma or cancer in four randomized adenoma prevention trials showed that aspirin reduced the occurrence of advanced adenomas by 28% and any adenoma by 17%. Aspirin has also been shown to be beneficial in a clinical trial of patients with Lynch syndrome, a hereditary CRC syndrome; in those treated with aspirin for at least two years, there was a 50% or more reduction in the risk of CRC commencing five years after randomization and after aspirin had been discontinued. A few observational studies have shown an increase in survival among patients with CRC who use aspirin. Taken together, these findings strengthen the case for consideration of long-term aspirin use in CRC prevention. Despite these compelling data, there is a lack of consensus about the balance of risks and benefits associated with long-term aspirin use, particularly in low-risk populations. The optimal dose to use for cancer prevention and the precise mechanism underlying aspirin's anticancer effect require further investigation.
authors.affiliation: Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA. achan@partners.org
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Chan
authors.forename: Nadir
authors.initials: N
authors.lastname: Arber
authors.forename: John
authors.initials: J
authors.lastname: Burn
authors.forename: Whay Kuang
authors.initials: WK
authors.lastname: Chia
authors.forename: Peter
authors.initials: P
authors.lastname: Elwood
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hull
authors.forename: Richard F
authors.initials: RF
authors.lastname: Logan
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rothwell
authors.forename: Karsten
authors.initials: K
authors.lastname: Schrör
authors.forename: John A
authors.initials: JA
authors.lastname: Baron
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D006801:Humans
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin
references.citation: Cancer Prev Res (Phila). 2011 May;4(5):655-65
references.pmid: 21543343
references.citation: Cancer. 1985 Apr 1;55(7):1586-9
references.pmid: 3978552
references.citation: Cancer Prev Res (Phila). 2008 Jun;1(1):32-8
references.pmid: 18841250
references.citation: Fam Cancer. 2011 Mar;10(1):11-20
references.pmid: 21052851
references.citation: Lancet. 2010 Nov 20;376(9754):1741-50
references.pmid: 20970847
references.citation: Am J Gastroenterol. 2009 Mar;104(3):739-50
references.pmid: 19240699
references.citation: J Clin Invest. 2001 Jul;108(1):7-13
references.pmid: 11435450
references.citation: N Engl J Med. 1991 Oct 31;325(18):1261-6
references.pmid: 1922220
references.citation: J Natl Cancer Inst. 1997 Aug 6;89(15):1152-60
references.pmid: 9262254
references.citation: Cancer Epidemiol Biomarkers Prev. 2006 Oct;15(10):1785-90
references.pmid: 17035383
references.citation: N Engl J Med. 1993 May 6;328(18):1313-6
references.pmid: 8385741
references.citation: Pathologe. 1998 Jul;19(4):269-78
references.pmid: 9746911
references.citation: Gut. 2010 Dec;59(12):1670-9
references.pmid: 20844293
references.citation: Lancet. 2011 Jan 1;377(9759):31-41
references.pmid: 21144578
references.citation: Nat Rev Gastroenterol Hepatol. 2011 Jun 07;8(7):385-94
references.pmid: 21647198
references.citation: N Engl J Med. 2008 Dec 11;359(24):2567-78
references.pmid: 19073976
references.citation: Br J Clin Pharmacol. 1993 Mar;35(3):219-26
references.pmid: 8471398
references.citation: Med J Aust. 2010 Dec 6-20;193(11-12):648-52
references.pmid: 21143050
references.citation: Dig Dis Sci. 2003 Oct;48(10):1998-2002
references.pmid: 14627347
references.citation: Biochem J. 2006 Feb 15;394(Pt 1):317-24
references.pmid: 16262603
references.citation: J Natl Cancer Inst. 1993 Aug 4;85(15):1220-4
references.pmid: 8331682
references.citation: Cancer Res. 2006 Apr 15;66(8):4542-6
references.pmid: 16618783
references.citation: Gut. 2011 Apr;60(4):491-8
references.pmid: 21051449
references.citation: Clin Radiol. 1984 Nov;35(6):425-31
references.pmid: 6499378
references.citation: Ann Intern Med. 2007 Mar 6;146(5):376-89
references.pmid: 17339623
references.citation: Am J Med. 2011 May;124(5):426-33
references.pmid: 21531232
references.citation: Ann Intern Med. 2008 Nov 4;149(9):627-37
references.pmid: 18838716
references.citation: Proc Natl Acad Sci U S A. 2003 Jun 24;100(13):7859-64
references.pmid: 12810952
references.citation: Mol Med. 1996 Sep;2(5):583-96
references.pmid: 8898374
references.citation: Gut. 2006 Jan;55(1):115-22
references.pmid: 16118353
references.citation: Carcinogenesis. 1992 Apr;13(4):541-6
references.pmid: 1315625
references.citation: Cell. 1996 Nov 29;87(5):803-9
references.pmid: 8945508
references.citation: Lancet. 2007 May 12;369(9573):1603-13
references.pmid: 17499602
references.citation: Lancet. 1991 Nov 30;338(8779):1345-9
references.pmid: 1682734
references.citation: N Engl J Med. 2005 May 26;352(21):2184-92
references.pmid: 15917383
references.citation: Gastroenterology. 2007 Aug;133(2):393-402
references.pmid: 17681160
references.citation: Ann Intern Med. 2009 Mar 17;150(6):379-86
references.pmid: 19293071
references.citation: Clin Gastroenterol Hepatol. 2011 Sep;9(9):762-768.e6
references.pmid: 21699808
references.citation: Circulation. 2003 Oct 7;108(14):1682-7
references.pmid: 14504182
references.citation: N Engl J Med. 2007 May 24;356(21):2131-42
references.pmid: 17522398
references.citation: Cancer Res. 1996 Oct 15;56(20):4566-9
references.pmid: 8840961
references.citation: Lancet. 1998 Jan 24;351(9098):233-41
references.pmid: 9457092
references.citation: J Thromb Haemost. 2011 Apr;9(4):790-8
references.pmid: 21251196
references.citation: Circulation. 2003 Jul 29;108(4):399-406
references.pmid: 12874182
references.citation: Gastroenterology. 2008 Jan;134(1):29-38
references.pmid: 18022173
references.citation: N Engl J Med. 2006 Aug 31;355(9):873-84
references.pmid: 16943400
references.citation: JAMA. 2008 Nov 12;300(18):2134-41
references.pmid: 18997198
references.citation: JAMA. 2010 Mar 3;303(9):841-8
references.pmid: 20197530
references.citation: Gastroenterology. 2006 Dec;131(6):1674-82
references.pmid: 17087947
references.citation: Chest. 2008 Jun;133(6 Suppl):199S-233S
references.pmid: 18574266
references.citation: JAMA. 2005 Aug 24;294(8):914-23
references.pmid: 16118381
references.citation: Cancer Prev Res (Phila). 2009 Apr;2(4):310-21
references.pmid: 19336730
references.citation: JAMA. 2005 Jul 6;294(1):47-55
references.pmid: 15998890
references.citation: Ann Intern Med. 2007 Mar 6;146(5):361-4
references.pmid: 17339621
references.citation: N Engl J Med. 1999 Jan 14;340(2):101-7
references.pmid: 9887161
references.citation: Lancet. 1992 Dec 12;340(8833):1421-5
references.pmid: 1360557
references.citation: Lancet Oncol. 2009 May;10(5):501-7
references.pmid: 19410194
references.citation: World J Surg. 1991 Jan-Feb;15(1):3-6
references.pmid: 1994603
references.citation: J Natl Cancer Inst. 2007 Apr 18;99(8):608-15
references.pmid: 17440162
references.citation: N Engl J Med. 2003 Mar 6;348(10):883-90
references.pmid: 12621132
references.citation: J Clin Oncol. 2007 Aug 10;25(23):3462-8
references.pmid: 17687150
references.citation: N Engl J Med. 2005 Mar 31;352(13):1293-304
references.pmid: 15753114
references.citation: Cancer Prev Res (Phila). 2011 Nov;4(11):1808-15
references.pmid: 21680706
references.citation: Int J Cancer. 2007 Sep 15;121(6):1325-30
references.pmid: 17487832
references.citation: Cancer. 2009 Dec 15;115(24):5662-71
references.pmid: 19827153
references.citation: Cell Prolif. 2009 Dec;42(6):721-30
references.pmid: 19706045
references.citation: BMJ. 2008 Oct 16;337:a1840
references.pmid: 18927173
references.citation: Nat Rev Cancer. 2010 Jul;10(7):489-503
references.pmid: 20555359
references.citation: Cancer Epidemiol Biomarkers Prev. 2005 Oct;14(10):2353-8
references.pmid: 16214916
references.citation: Gastroenterology. 2008 Jan;134(1):21-8
references.pmid: 18005960
references.citation: N Engl J Med. 1989 Jul 20;321(3):129-35
references.pmid: 2664509
references.citation: PLoS One. 2010 Dec 29;5(12):e15721
references.pmid: 21209949
references.citation: J Natl Cancer Inst. 2009 Feb 18;101(4):256-66
references.pmid: 19211452
references.citation: FASEB J. 2006 Oct;20(12):2009-16
references.pmid: 17012253
references.citation: N Engl J Med. 2005 Dec 1;353(22):2373-83
references.pmid: 16319386
references.citation: J Gastroenterol. 2009;44 Suppl 19:77-81
references.pmid: 19148798
references.citation: J Natl Cancer Inst. 1998 Aug 19;90(16):1212-8
references.pmid: 9719082
references.citation: Am J Gastroenterol. 2011 Jun;106(6):1135-46
references.pmid: 21503000
references.citation: N Engl J Med. 1991 Dec 5;325(23):1593-6
references.pmid: 1669840
references.citation: Arch Intern Med. 2007 Mar 26;167(6):562-72
references.pmid: 17389287
references.citation: Am J Gastroenterol. 2011 Jul;106(7):1340-50
references.pmid: 21407185
references.citation: N Engl J Med. 2000 Jun 29;342(26):1946-52
references.pmid: 10874062
references.citation: JAMA. 2009 Aug 12;302(6):649-58
references.pmid: 19671906
references.citation: Stroke. 2005 Aug;36(8):1801-7
references.pmid: 16020759
references.citation: Gut. 2012 Jan;61(1):135-49
references.pmid: 21490374
references.citation: Br Med J (Clin Res Ed). 1988 Jan 30;296(6618):313-6
references.pmid: 3125882
references.citation: Lancet. 2009 May 30;373(9678):1849-60
references.pmid: 19482214
references.citation: Praxis (Bern 1994). 2001 Mar 22;90(12):483-9
references.pmid: 11324307
references.citation: Lancet. 2011 Dec 17;378(9809):2081-7
references.pmid: 22036019
references.citation: N Engl J Med. 2003 Mar 6;348(10):891-9
references.pmid: 12621133
references.citation: Clin Exp Rheumatol. 2001 Nov-Dec;19(6 Suppl 25):S45-50
references.pmid: 11695252
references.citation: Ann Intern Med. 2009 Mar 17;150(6):396-404
references.pmid: 19293072
references.citation: BMJ. 1995 Apr 1;310(6983):827-30
references.pmid: 7711618
references.citation: Cancer Prev Res (Phila). 2012 Jan;5(1):61-72
references.pmid: 22030088
references.citation: Gastroenterology. 2010 Sep;139(3):797-805, 805.e1
references.pmid: 20538001
references.citation: Am J Cardiol. 2005 May 15;95(10):1218-22
references.pmid: 15877994
references.citation: Gut. 2010 Nov;59(11):1572-85
references.pmid: 20660702
references.citation: Gastroenterology. 2003 Aug;125(2):328-36
references.pmid: 12891533
references.citation: J Neurol Neurosurg Psychiatry. 1991 Dec;54(12):1044-54
references.pmid: 1783914
references.citation: Cancer Res. 2000 Sep 1;60(17):4705-8
references.pmid: 10987272
references.citation: JAMA. 1992 Sep 9;268(10):1292-300
references.pmid: 1507375
references.citation: BMJ. 2000 Nov 11;321(7270):1183-7
references.pmid: 11073508
references.citation: Am J Gastroenterol. 2010 Dec;105(12):2646-55
references.pmid: 20808298
references.citation: Arch Biochem Biophys. 1996 Jun 15;330(2):301-13
references.pmid: 8660660
references.citation: N Engl J Med. 2006 Aug 31;355(9):885-95
references.pmid: 16943401
references.citation: N Engl J Med. 2005 Mar 17;352(11):1092-102
references.pmid: 15713943
references.citation: Am J Med. 2006 Aug;119(8):624-38
references.pmid: 16887404
references.citation: Gut. 2010 Jul;59(7):918-25
references.pmid: 20348368
references.citation: Annu Rev Pathol. 2008;3:279-312
references.pmid: 18233953
references.citation: Circulation. 2006 Sep 5;114(10):1028-35
references.pmid: 16943394