Aspirin use and potential mechanisms for colorectal cancer prevention.

Abstract

Disease prevention is receiving more attention in the United States today. This welcome trend is largely a result of two economic forces: The increased level of support for prevention research by the National Institutes of Health (Healthy People 2000), and the potential payoff of prevention research in cutting the health care costs of managing patients with end-stage diseases. Indeed, the efficacy of preventive measures for many chronic diseases (such as heart disease and cancer) are being evaluated with the full expectation that mortality and morbidity—and perhaps health care costs—will decrease. One example of recent cancer prevention research indicates that there may be a 40–50% reduction in mortality from colorectal cancer in persons who take aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs) 1 on a regular basis. It is clear that an effect of this magnitude would have a significant impact on both the number of lives saved and on the health care dollars recovered. Colorectal cancer is a major cause of death in Western civilizations, claiming about 55,000 lives in the United States this year alone. Americans have a 1 in 20 lifetime risk of developing this disease, and z 1 in 10 have a family member who develops colorectal cancer. Initially, it was hoped that early detection would reduce these high numbers. However, despite recent evidence that early detection by fecal occult blood tests and flexible sigmoidoscopy can decrease the risk of colorectal cancer death by 20–30%, most people do not undergo appropriate screening. Therefore, a number of laboratories have initiated research efforts focused on understanding the molecular basis of the potential chemoprotective effects resulting from aspirin and other NSAID use. It is hoped that this approach, in conjunction with more rigorous clinical trials, will lead to a rationale design for future colorectal cancer prevention regimens. This Perspectives article considers both the clinical and the basic research efforts underway this year, the 100th anniversary of the discovery of aspirin.