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| **You Are Here:**AHRQ Home >  Clinical Information > U.S. Preventive Services Task Force > Topic Index >  Aspirin or Nonsteroidal Anti-inflammatory Drugs for the Primary Prevention of Colorectal Cancer 
 Aspirin or Nonsteroidal Anti-inflammatory Drugs for the Primary Prevention of Colorectal CancerU.S. Preventive Services Task Force
Release Date: March 2007

Summary of Recommendation / Supporting Documents
Summary of Recommendation- The USPSTF recommends against the routine useof aspirin and nonsteroidal anti-inflammatory drugs(NSAIDs) to prevent colorectal cancer in individuals ataverage risk for colorectal cancer.  **Rating: "D" recommendation.** 
Rationale
**Importance:** Colorectal cancer represents the third most commontype of cancer in both men and women and is the secondleading cause of cancer-related deaths in the United States.

**Recognition of risk status:**The vast majority of cases of colorectal cancer arisefrom adenomatous polyps in average-risk individuals olderthan 50 years of age.

**Benefits of aspirin and NSAID use:**There is fair to good evidence that aspirin andNSAIDs, taken in higher doses for longer periods, reducesthe incidence of adenomatous polyps.

There is good evidence that low-dose aspirin does notlead to a reduction in the incidence of colorectal cancer.

There is fair evidence that aspirin used in doses higherthan those recommended for prevention of cardiovasculardisease and NSAIDs may be associated with a reduction inthe incidence of colorectal cancer.

There is fair evidence that aspirin used over longerperiods may be associated with a reduction in the incidenceof colorectal cancer.

There is poor-quality evidence that aspirin andNSAID use leads to a reduction in colorectal cancer–associated mortality.

**Harms of aspirin and NSAID use:**There is good evidence that aspirin increases the incidenceof gastrointestinal bleeding in a dose-related mannerand fair evidence that aspirin increases the incidence ofhemorrhagic stroke.

There is good evidence that NSAIDs increase the incidenceof gastrointestinal bleeding and renal impairment,especially in the elderly.

There is good evidence that cyclooxygenase-2 inhibitors,a class of NSAID, increase the incidence of renalimpairment. Cyclooxygenase-2 inhibitors appear to be associatedwith an increased risk for cardiovascular events.

Overall, there is good evidence of at least moderateharms associated with aspirin and NSAIDs. 

**USPSTF assessment:**Overall, the USPSTF concluded that harms outweighthe benefits of aspirin and NSAID use for the preventionof colorectal cancer.

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Supporting Documents
Aspirin or Nonsteroidal Anti-inflammatory Drugs for the Primary Prevention of Colorectal Cancer, March 2007Recommendation Statement (PDF File, 135 KB; PDF Help)Aspirin for Primary Prevention of Colorectal Cancer: Systematic Review (PDF File, 300 KB; PDF Help)Nonsteroidal Anti-inflammatory Drugs and Cyclooxygenase-2 Inhibitors for Primary Prevention of Colorectal Cancer: Systematic Review (PDF File, 330 KB; PDF Help)Evidence Synthesis (PDF File, 3.6 MB; PDF Help)

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*Current as of March 2007*

**Internet Citation:**

*Aspirin or Nonsteroidal Anti-inflammatory Drugs for the Primary Prevention of Colorectal Cancer*, Topic Page.  March 2007. U.S. Preventive Services Task Force.  Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf/uspsasco.htm 

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