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Aspirin is the most widely studied drug for chemoprevention of colorectal cancer but there are limitations. First the risk-benefit issue has not been fully addressed. What is the risk of bleeding associated with prescribing aspirin to asymptomatic individuals versus the benefit of cancer protection one can obtain from this treatment? Second, the optimal dosing, frequency and duration of aspirin usage in average-risk subjects (ie, patients with non-cardiovascular disease and patients with non-familial polyposis) have not been settled. Third, the potential ethnic difference has not been studied. Up to now, almost all studies were conducted in the Western population. Would Asians be responding to the treatment equally well?
There are new and important data to support the use of aspirin in preventing colorectal cancer (CRC). Rothwell et al recently published their long-term data in 20-year follow-up studies giving strong support to the use of low-dose aspirin (75–300 mg daily) in cancer prevention.1 ,2 These data which pool from five important randomised studies examine the effects of primary (Thrombosis Prevention Trial, British Doctors Aspirin Trial) and secondary (Swedish Aspirin Low Dose Trial, UK-TIA trial, Dutch TIA trial) included over 14 000 patients with a median follow-up of more than 18 years. The long-term use of aspirin resulted in significant reduction of colon cancer incidence …