Aspirin and the prevention of colorectal cancer: a review of the evidence.

In all but one of seven recent epidemiologic case-control and cohort studies directly examining the association between aspirin and colorectal cancer and polyps, regular aspirin use reduced the risk of these diseases by about half. Although these studies show a biologically plausible relationship between aspirin and colorectal cancer, information regarding dose and duration and risk change after discontinuation of aspirin is limited and contradictory. Additionally, selection bias, recall bias, and confounding cannot be completed discounted. The one randomized trial of aspirin and placebo showed that aspirin at a dose adequate for preventing myocardial infarction (325 mg every other day) did not reduce colorectal cancer incidence during five years of randomized treatment and follow-up. Further studies need to determine the biologic effects of aspirin, the minimum dose required, and whether other factors, such as age, illnesses, and reasons for aspirin use, modify or confound colorectal cancer development.