Harms outweigh benefits of aspirin/NSAID for colon cancer prevention
Clinical Question
Should patients be advised to take aspirin or a nonsteroidal anti-inflammatory drug to prevent colorectal cancer?
Bottom Line
The US Preventive Services Task Force recommends against routine use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent colorectal cancer. The beneficial decrease in colorectal adenoma, cancer incidence, and possibly cancer-related mortality is more than offset by the harm associated with their use. Ulcers leading to gastrointestinal bleeding, renal impairment, and an increase in cardiovascular events are the main problems. (LOE = 1a)
Reference
U.S. Preventive Services Task Force. Routine aspirin or nonsteroidal anti-inflammatory drugs for the primary prevention of colorectal cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2007;146:361-364. Rostom A, Dube C, Lewin G, et al. 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. Ann Intern Med 2007;146:376-389. [PMID:17339623]
Study Design
Practice guideline
Funding
Government
Setting
Various (guideline)
Synopsis
This guideline is based on a systematic review of randomized trials, case-control studies, and cohort studies evaluating the effectiveness and safety of using either aspirin or NSAIDs to prevent colorectal cancer. Although the single cohort study of aspirin showed no effect on colorectal cancer-related mortality, studies of various NSAIDs showed a decrease in adenoma cancer incidence and one study showed a decrease in mortality due to all causes but not a reduction in colorectal cancer-related mortality. However, this benefit is contrasted with an increase risk of ulcer development (approximately 1.5% per year), renal impairment, and an increased risk of serious cardiovascular events.
Citation
Barry, Henry, et al., editors. "Harms Outweigh Benefits of aspirin/NSAID for Colon Cancer Prevention." EE+ POEM Archive, John Wiley & Sons, 2025. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426437/all/Harms_outweigh_benefits_of_aspirin_NSAID_for_colon_cancer_prevention.
Harms outweigh benefits of aspirin/NSAID for colon cancer prevention. In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2025. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426437/all/Harms_outweigh_benefits_of_aspirin_NSAID_for_colon_cancer_prevention. Accessed February 9, 2025.
Harms outweigh benefits of aspirin/NSAID for colon cancer prevention. (2025). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426437/all/Harms_outweigh_benefits_of_aspirin_NSAID_for_colon_cancer_prevention
Harms Outweigh Benefits of aspirin/NSAID for Colon Cancer Prevention [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2025. [cited 2025 February 09]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426437/all/Harms_outweigh_benefits_of_aspirin_NSAID_for_colon_cancer_prevention.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Harms outweigh benefits of aspirin/NSAID for colon cancer prevention
ID - 426437
ED - Barry,Henry,
ED - Ebell,Mark H,
ED - Shaughnessy,Allen F,
ED - Slawson,David C,
BT - EE+ POEM Archive
UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426437/all/Harms_outweigh_benefits_of_aspirin_NSAID_for_colon_cancer_prevention
PB - John Wiley & Sons
DB - Evidence Central
DP - Unbound Medicine
ER -