Should aspirin be used for primary prevention of colorectal cancer in the general population?

ABSTRACT

Objectives: The objective of this narrative review is to determine if aspirin is indicated for primary prevention of colorectal cancer in the general population. Methods: A Pubmed search was conducted and 19 articles were included for this review. Results and Discussion: In deciding if aspirin should be recommended for chemoprevention, we need to consider its efficacy, safety profile, patient compliance and cost-effectiveness. Most of the observation studies suggested that aspirin had a protective effect against colorectal cancer. However, randomised control trials had not shown such benefit. For the general population, the harms of aspirin outweigh the potential benefits. A long duration of 5-10 years of regular aspirin intake seemed to be required for significant protective effect. As such, compliance in the long term for an otherwise well patient is an issue. While some cost-effectiveness analyses suggested that colonoscopic screening was more cost-effective than aspirin use, others suggested that a combination of low-dose aspirin with colonoscopy was cost-effective, especially for proximal colorectal cancer. Conclusion: Based on the data from RCTs thus far, aspirin should not be recommended as a chemo-preventive agent against colorectal cancer for the general population.