Prevention of colorectal cancer by aspirin and/or calcium: Efficacy, mechanisms, and cost effectiveness

Barbara C. Pence, Eric J. Belasco, Conrad P. Lyford

Research output: Contribution to journalArticle

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Abstract

Chemoprevention of colorectal cancer (CRC) by aspirin use or calcium supplementation has been studied for almost two decades. Recently, the use of aspirin has been reported to be efficacious for the chemoprevention of CRC at the lowest dose ever, one that corresponds to that recommended for the primary prevention of cardiovascular disease. There is also new evidence that aspirin at higher doses may be helpful in controlling familial adenomatous poly-posis (FAP). Several cost effectiveness studies have emerged to demonstrate that use of aspirin in combination with colonoscopy is cost-effective compared with colono-scopy alone in prevention of CRC. Likewise, calcium supplementation in a chemoprevention strategy also has been shown to be cost-effective when used alone or in combination with colonoscopy in CRC prevention, compared to natural history. The chemopreventive mechanisms of these agents continue to be studied, and prominent molecular targets for aspirin are cyclooxygenase (COX)-2, and perhaps COX-1, as well as the calcium-sensing receptor (CaSR) as the likely target for calcium supplementation. The evidence is compelling for the widespread use of these non-prescription agents, either alone or in combination, for either primary prevention of CRC in the general population, or as part of a colonoscopy surveillance program in high-risk populations with a prior adenoma.

Original languageEnglish
Pages (from-to)51-56
Number of pages6
JournalCurrent Colorectal Cancer Reports
Volume8
Issue number1
DOIs
StatePublished - Mar 1 2012

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Keywords

  • Aspirin
  • COX-2
  • Calcium
  • Calcium-sensing receptor
  • Chemoprevention
  • Colonoscopy
  • Colorectal cancer
  • Cost-effectiveness
  • Markov simulation

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