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.