Aspirin in the Prevention of Colorectal Neoplasia

High-quality evidence indicates that regular use of aspirin is effective in reducing the risk for precancerous colorectal neoplasia and colorectal cancer (CRC). This has led to US and international guidelines recommending aspirin for the primary prevention of CRC in specific populations. In this rev...

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Bibliographic Details
Published in:Annual review of medicine 2021-01, Vol.72 (1), p.415-430
Main Authors: Drew, David A, Chan, Andrew T
Format: Article
Language:English
Subjects:
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Aspirin
Aspirin - therapeutic use
chemoprevention
Chemoprevention - methods
Colorectal cancer
Colorectal carcinoma
Colorectal Neoplasms - prevention & control
Humans
Intestinal microflora
Microbiota
nonsteroidal anti-inflammatory drugs
personalized medicine
precision chemoprevention
Precision Medicine - methods
Prevention
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Summary:High-quality evidence indicates that regular use of aspirin is effective in reducing the risk for precancerous colorectal neoplasia and colorectal cancer (CRC). This has led to US and international guidelines recommending aspirin for the primary prevention of CRC in specific populations. In this review, we summarize key questions that require addressing prior to broader adoption of aspirin-based chemoprevention, review recent evidence related to the benefits and harms of aspirin use among specific populations, and offer a rationale for precision prevention approaches. We specifically consider the mechanistic implications of evidence showing differences in aspirin's effects according to age, the potential role of modifiable mechanistic biomarkers for personalizing prevention, and emerging evidence that the gut microbiota may offer novel aspirin-associated preventive targets to reduce high-risk neoplasia.
ISSN:0066-4219
1545-326X
1545-326X
DOI:10.1146/annurev-med-060319-120913