Abandon chemoprevention for colorectal cancer

doi:10.1136/bmj.334.7593.559-b

BMJ 2007;334:559 (17 March), doi:10.1136/bmj.334.7593.559-b

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Abandon chemoprevention for colorectal cancer

The first 150 words of the full text of this article appear below.

The US preventive services task force has warned doctors notto prescribe aspirin or non-steroidal anti-inflammatory drugsto prevent colorectal cancer. The recommendation follows twosystematic reviews showing that the risks of primary preventionwith any drug, including cyclo-oxygenase-2 inhibitors, outweighthe benefits (pp 365-75, pp 376-89).

Low dose aspirin does not seem to protect people at averagerisk from colorectal cancer. A higher dose taken for up to 12years reduces the risk by about 22% (relative risk 0.78, 95%CI 0.63 to 0.97), but it also causes gastrointestinal bleedingand possibly haemorrhagic stroke. Non-steroidal anti-inflammatorydrugs probably help prevent colorectal cancer, although thetask force describes the evidence as fair. It's still unclearwhether any of these agents save lives. The evidence weighingin on the other side is good: non-steroidal anti-inflammatorydrugs cause gastrointestinal bleeding and renal impairment,while cyclo-oxygenase-2 inhibitors increase the risk of cardiovasculardisease.