title: Chemoprevention of colorectal neoplasia.
abstract: BACKGROUND
  Colorectal cancer is a common and often fatal malignancy. Currently, the modifications that alter disease outcome include early symptom recognition, population screening as well as improved surgical and adjuvant treatments. Preventative strategies have been limited with little evidence that lifestyle changes significantly alter risk. There is however a growing awareness of a potential role for chemoprevention in some patient groups. This study aimed to review the literature associated with chemoprevention in colorectal cancer.
  
  
  METHODS
  An electronic literature search of MEDLINE and Embase databases was performed on PubMed for studies detailing the use of chemoprevention agents in colon and rectal cancer. The search was limited to clinical trials on adult humans (>16 years of age) published in English since 1990.
  
  
  RESULTS
  The strongest evidence is for non-steroidal anti-inflammatory drugs slowing polyp progression, notably Sulindac and aspirin in patients with familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, respectively. There is also increasing evidence that continuing use of low-dose aspirin reduces long-term incidence of colorectal cancers. Cyclooxygenase 2 inhibitors also have a potential role but cardiac toxicity currently limits their use. Folic acid, statins, antioxidants, calcium and 5-aminosalicylic acid lack evidence to support their use at present.
  
  
  CONCLUSIONS
  Currently, there is not enough evidence to support the implementation of a chemopreventative agent for general use. However, there appears to be a role for aspirin in selected subgroups.
authors.affiliation: Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.|New Zealand Familial Gastrointestinal Cancer Service, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Chris
authors.initials: C
authors.lastname: Wakeman
authors.affiliation: Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Keenan
authors.affiliation: Colorectal Unit, Flinders Medical Center, Adelaide, South Australia, Australia.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Eteuati
authors.affiliation: Colorectal Unit, Flinders Medical Center, Adelaide, South Australia, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Hollington
authors.affiliation: Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Tim
authors.initials: T
authors.lastname: Eglinton
authors.affiliation: Colorectal Unit, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Frank
authors.initials: F
authors.lastname: Frizelle
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000188:drug therapy / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D066126:Cardiotoxicity / Q000150:complications; D018890:Chemoprevention / Q000009:adverse effects* / Q000191:economics / Q000379:methods*; D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000188:drug therapy / Q000517:prevention & control*; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D018450:Disease Progression; D006801:Humans; D015994:Incidence; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D013467:Sulindac / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D013467:Sulindac; D001241:Aspirin
keywords: adenoma; aspirin; chemoprophylaxis; colon cancer; prevention