Chemoprevention of Colorectal Cancer—With Emphasis on Low-Dose Aspirin and Anticoagulants
<b>Background and Aims:</b> Colorectal cancer (CRC) remains the third most common cancer worldwide and a leading cause of cancer-related death. Chemoprevention through widely used pharmaceutical agents has garnered increasing interest due to its potential cost-effectiveness and accessibi...
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MDPI AG
2025-05-01
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| Series: | Pharmaceuticals |
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| Online Access: | https://www.mdpi.com/1424-8247/18/6/811 |
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| author | Arnar Snaer Agustsson Einar Stefan Bjornsson |
| author_facet | Arnar Snaer Agustsson Einar Stefan Bjornsson |
| author_sort | Arnar Snaer Agustsson |
| collection | DOAJ |
| description | <b>Background and Aims:</b> Colorectal cancer (CRC) remains the third most common cancer worldwide and a leading cause of cancer-related death. Chemoprevention through widely used pharmaceutical agents has garnered increasing interest due to its potential cost-effectiveness and accessibility. This review summarizes current evidence from observational studies, randomized controlled trials, and meta-analyses on the association between commonly prescribed medications and CRC incidence and survival, with particular emphasis on low-dose aspirin and oral anticoagulants (OACs). <b>Scope:</b> Aspirin is the most extensively studied agent, with substantial evidence supporting its protective effect on CRC-specific survival, particularly in long-term users, those with COX-2 overexpression, or PIK3CA mutations. OACs have recently gained attention due to their association with increased gastrointestinal bleeding, which may facilitate earlier CRC detection. While emerging evidence suggests a possible survival benefit through this mechanism, data remain heterogeneous and affected by methodological challenges such as lead-time bias. Metformin is associated with improved CRC outcomes, primarily in patients with type 2 diabetes, though its direct anti-tumor potential remains under investigation. Corticosteroids, statins, and beta-blockers have both limited and inconclusive evidence. Finally, recent studies on vitamin D, calcium, and folic acid suggest inconsistent associations, often confounded by lifestyle factors or underlying comorbidities. <b>Conclusions:</b> While promising, chemoprevention strategies require further validation in well-designed, mechanistically informed studies that account for confounding variables, treatment duration, and tumor biology. Personalized prevention—guided by genetic, molecular, and clinical risk factors—represents a promising path forward. |
| format | Article |
| id | doaj-art-9019f685b11f47c68247e0f8b6f616ca |
| institution | Kabale University |
| issn | 1424-8247 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
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| series | Pharmaceuticals |
| spelling | doaj-art-9019f685b11f47c68247e0f8b6f616ca2025-08-20T03:27:39ZengMDPI AGPharmaceuticals1424-82472025-05-0118681110.3390/ph18060811Chemoprevention of Colorectal Cancer—With Emphasis on Low-Dose Aspirin and AnticoagulantsArnar Snaer Agustsson0Einar Stefan Bjornsson1Faculty of Medicine, Landspitali, University Hospital of Iceland, 101 Reykjavik, IcelandFaculty of Medicine, Landspitali, University Hospital of Iceland, 101 Reykjavik, Iceland<b>Background and Aims:</b> Colorectal cancer (CRC) remains the third most common cancer worldwide and a leading cause of cancer-related death. Chemoprevention through widely used pharmaceutical agents has garnered increasing interest due to its potential cost-effectiveness and accessibility. This review summarizes current evidence from observational studies, randomized controlled trials, and meta-analyses on the association between commonly prescribed medications and CRC incidence and survival, with particular emphasis on low-dose aspirin and oral anticoagulants (OACs). <b>Scope:</b> Aspirin is the most extensively studied agent, with substantial evidence supporting its protective effect on CRC-specific survival, particularly in long-term users, those with COX-2 overexpression, or PIK3CA mutations. OACs have recently gained attention due to their association with increased gastrointestinal bleeding, which may facilitate earlier CRC detection. While emerging evidence suggests a possible survival benefit through this mechanism, data remain heterogeneous and affected by methodological challenges such as lead-time bias. Metformin is associated with improved CRC outcomes, primarily in patients with type 2 diabetes, though its direct anti-tumor potential remains under investigation. Corticosteroids, statins, and beta-blockers have both limited and inconclusive evidence. Finally, recent studies on vitamin D, calcium, and folic acid suggest inconsistent associations, often confounded by lifestyle factors or underlying comorbidities. <b>Conclusions:</b> While promising, chemoprevention strategies require further validation in well-designed, mechanistically informed studies that account for confounding variables, treatment duration, and tumor biology. Personalized prevention—guided by genetic, molecular, and clinical risk factors—represents a promising path forward.https://www.mdpi.com/1424-8247/18/6/811colorectal canceraspirinoral anticoagulationmetforminchemopreventionpharmacoepidemiology |
| spellingShingle | Arnar Snaer Agustsson Einar Stefan Bjornsson Chemoprevention of Colorectal Cancer—With Emphasis on Low-Dose Aspirin and Anticoagulants Pharmaceuticals colorectal cancer aspirin oral anticoagulation metformin chemoprevention pharmacoepidemiology |
| title | Chemoprevention of Colorectal Cancer—With Emphasis on Low-Dose Aspirin and Anticoagulants |
| title_full | Chemoprevention of Colorectal Cancer—With Emphasis on Low-Dose Aspirin and Anticoagulants |
| title_fullStr | Chemoprevention of Colorectal Cancer—With Emphasis on Low-Dose Aspirin and Anticoagulants |
| title_full_unstemmed | Chemoprevention of Colorectal Cancer—With Emphasis on Low-Dose Aspirin and Anticoagulants |
| title_short | Chemoprevention of Colorectal Cancer—With Emphasis on Low-Dose Aspirin and Anticoagulants |
| title_sort | chemoprevention of colorectal cancer with emphasis on low dose aspirin and anticoagulants |
| topic | colorectal cancer aspirin oral anticoagulation metformin chemoprevention pharmacoepidemiology |
| url | https://www.mdpi.com/1424-8247/18/6/811 |
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