Abstract
BackgroundColorectal cancer (CRC) is a leading cause of cancer morbidity and mortality. People at higher risk are those individuals with a family history of CRC and familial adenomatous polyposis. Prevention and screening are two milestones for this disease. The aim of this study is to evaluate the chemopreventive role of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and cyclooxygenase 2 inhibitors, some micronutrients (folic acid, calcium, selenium, antioxidants) and probiotics.DiscussionThe studies on aspiring reported promising results, but it is debatable whether aspirin should be used as chemoprevention, because of its side effects and because of poor efficacy evident in subjects at high risk. Similar results were reported for other non-aspirin NSAIDs, such as sulindac and celecoxib, which the potential adverse effects limit their use. Selenium role in prevention of various types of cancer as well as in colon adenomas are often inconclusive or controversial. Several studies suggested that calcium may have a possible chemopreventive effect on colon adenomas and CRC, although contrasting results are reported for the latter. A recent meta-analysis including 13 randomized trial suggested that folic acid supplementation had not a chemiopreventive action on CRC. Several studies investigated the association between antioxidants, administered alone or in combination, and CRC risk, both among general and at risk population, but only few of them supported statistically significant results.ConclusionThe results of this literature review showed an unclear role in CRC prevention of both pharmacological and dietary intervention. Despite several options are available to prevent colon cancer, it is challenging to identify a correct strategy to prevent CRC through pharmacological and dietary intervention due to the long latency of cancer promotion and development. Since some of the drugs investigated may have uncertain individual effects, it can be suggested to potentiate such effects by adding them together.
Highlights
Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality
The results of this literature review showed an unclear role in CRC prevention of both pharmacological and dietary intervention
Similar findings were observed in subsequent studies, such as the Health Professionals Follow-up Study (HPFS) and the US Nurses’ Health Study (NHS) cohort, which talked about an hazard reduction respectively equal to 21% in a cohort of men and 23% in a cohort of women only [25,26]
Summary
Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality. People at higher risk are those individuals with a family history of CRC and familial adenomatous polyposis. Despite the recent development in drug therapy against CRC are promising [12,13], primary prevention interventions against colorectal cancer mostly involve dietary measures, a pharmacological approach demonstrated to be effective in selected subjects. Aspirin is a salicylate drug, nowadays mainly used as an analgesic to calm minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication It plays an important role in hypertension and in other cardiovascular diseases [15]. Nausea and dyspepsia are milder adverse reactions, and the most frequent [17] Because of his already mentioned antiplatelet effect, the use of aspirin in association with other drugs that increase the risk of bleeding must be controlled. Aspirin should be used with prudence in the elderly, because of the risk of Reye’s syndrome [18] and in individuals with favism, recent studies have shown a good tolerance to low doses of the drug in these patients [19]
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