Aspirin, NSAIDs Not Recommended for Prevention of Colon Cancer

Since 1984 the U. S. Preventative Services Task Force, a panel of 16 academic medical experts, has issued advice regarding preventative treatments. It regards itself as (if I may quote from their own humble self-description) "the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the 'gold standard' for clinical preventive services."

Well! Who could argue with that pronouncement? Good thing for us they're not bashful, for the Task Force's scrutiny has fallen upon a habit that I always believed was helpful, viz., the use of aspirin or NSAIDs such as ibuprofen or naproxen to prevent the development of colon cancer. The Force (may they always be with us) has reviewed reams of data regarding the efficacy of aspirin and NSAIDs (non-steroidal anti-inflammatory drugs) in preventing colon cancer and announced the following from Mount Olympus:

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.

Hmm...for this they met for 10 months at the Plaza Athénée? Oh, wait - that was just the intro. For the true conclusions vide infra...

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

Based on this thorough review we all can now say the following with confidence:

"Aspirin is a stinker? That's no military secret!"
"Ja, everybody knows that !"