Nonsteroidal Anti-inflammatory Drugs (NSAID)

Numerous observational epidemiological studies have found that long-term users of aspirin or other NSAIDs have a lower risk of colorectal adenomatous polyps and colorectal cancer than non-users. Randomised clinical trials have confirmed that two NSAIDs, the prodrug sulindac and selective cyclooxygenese (COX)-2 inhibitor celecoxib, effectively inhibit the growth of adenomatous polyps and cause regression of existing polyps in patients with familial adenomatous polyposis (FAP) [32,33]. Less promising are results on the far more common sporadic adenomatous polyps. Treatment with sulindac did not result in regression of sporadic adenomas [34] or doses required to achieve the effect may cause toxicity, which outweighs the benefits of treatment [35].

Despite some positive results obtained in studies in humans and coupled with biological plausibility [36], the efficacy of long-term NSAIDs prophylaxis against colorectal cancer, and other cancers, remains unproven. Recommendations regarding the use of NSAIDs for prevention of colorectal cancer, except probably the use of celecoxib or sulindac for control of the growth of colorectal adenomas among patients with FAP, appears to be premature at the present time.