Can an Aspirin a Day Keep the Colorectal Cancer Away?

Colorectal cancer (CRC) is a major health concern. The progression of normal mucosa through adenoma to overt adenocarcinomas span over more than a decade. It provides a window of opportunities for early detection as well as the use of chemopreventive agents such as aspirin. Indeed, CRC can be prevented in up to 80-90% of the cases providing that physicians and patients compliance with current preventive strategies is high. Epidemiological and clinical randomised studies have clearly demonstrated an association between increasing aspirin use and incidence, prevalence and mortality from CRC. Although the evidence supporting the effect of aspirin on colorectal adenomas (CRA) and CRC prevention is consistent, a greater understanding of its mode of action is still needed. Incorporating CRC and CRA benefits into ischemic heart disease (IHD) and Alzheimer disease risk scores would be particularly useful for determining the benefit-to-risk ratio for aspirin use in borderline cases. For instance, patients with a border line annual IHD risk, around 0.7-1.4%, but with a high risk for CRC may still benefit from aspirin usage.