Aspirin or Nonsteroidal Anti-inflammatory Drugs for the Prevention of Colorectal Cancer: U.S. Preventive Services Task Force Recommendations

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The summary below is from the full reports titled "Routine Aspirin or Nonsteroidal Anti-inflammatory Drugs for the Primary Prevention of Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement," "The Use of Aspirin for Primary Prevention of Colorectal Cancer: A Systematic Review Prepared for the U.S. Preventive Services Task Force," and "Nonsteroidal Anti-inflammatory Drugs and Cyclooxygenase-2 Inhibitors for Primary Prevention of Colorectal Cancer. A Systematic Review Prepared for the U.S. Preventive Services Task Force." They are in the 6 March 2007 issue of Annals of Internal Medicine (volume 146, pages 361-364, pages 365-375, and pages 376-389). The first report was written by the U.S. Preventive Services Task Force; the second report was written by C. Dubé, A. Rostom, G. Lewin, A. Tsertsvadze, N. Barrowman, C. Code, M. Sampson, and D. Moher; and the third report was written by A. Rostom, C. Dubé, G. Lewin, A. Tsertsvadze, N. Barrowman, C. Code, M. Sampson, and D. Moher, for the U.S. Preventive Services Task Force.

Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Colorectal cancer is cancer of the colon (large intestine) or rectum. Screening decreases deaths due to colorectal cancer by detecting precancerous abnormalities (polyps) and removing them before they become cancerous and by detecting cancer in an early stage when it can still be cured with surgery. Chemoprevention is another strategy to prevent colorectal cancer. Chemoprevention means taking a drug to reduce the risk for a disease. Studies suggest that taking high doses of daily aspirin or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, may reduce a person’s risk for polyps and colorectal cancer. However, theses drugs have side effects. Whether people should routinely take aspirin or NSAIDs to reduce their risk for colorectal cancer depends on whether the benefits of colorectal cancer reduction outweigh the risks for side effects.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research to evaluate the benefits and harms of taking aspirin or NSAIDs to prevent colorectal cancer.

What did the authors find?

Fair to good studies show that aspirin or NSAIDs taken in high doses for long periods reduce the risk for polyps and colorectal cancer. However, there is little evidence that taking these drugs reduces the risk for dying from colorectal cancer. Good studies also show that taking low-dose aspirin (the amount recommended to prevent heart attack and stroke in people at risk for these conditions) does not reduce the risk for colorectal cancer. Good studies show that side effects are associated with taking aspirin or NSAIDs at doses that might prevent colorectal cancer. These side effects include bleeding in the gastrointestinal tract for both aspirin and NSAIDs, bleeding into the brain for aspirin, and kidney problems or cardiovascular disease for NSAIDs.

What does the USPSTF suggest that patients and doctors do?

The USPSTF recommends against the routine use of aspirin or NSAIDs to prevent colorectal cancer in people at average risk for the disease.

What are the cautions related to these recommendations?

These recommendations do not apply to patients with a personal history of colorectal cancer or other conditions that put them at high risk for the disease.