Aspirin for colorectal cancer chemoprevention: where are we?

Purpose of review: Aspirin (acetylsalicylic acid, ASA) is gaining recognition as a possible chemopreventive agent for colorectal cancer (CRC). This review explores current evidence on ASA use in both primary and secondary prevention of CRC among sporadic cases and in patients with Lynch syndrome (LS).

Recent findings: Observational cohorts consistently indicate a modest, time-dependent reduction in CRC incidence with long-term ASA use, especially in individuals with elevated baseline risk. In LS, extended follow-up from randomized trials reveals a robust protective effect, although the ideal dose remains unsettled. For secondary prevention, randomized trials in unselected patients did not detect a clear advantage, on the other hand tumors harboring Phosphatidylinositol-4,5-Bisphosphate 3-Kinase Catalytic Subunit Alpha (PIK3CA)-mutation have a substantial gains in recurrence prevention, emphasizing the role of molecular stratification.

Summary: Accumulating evidence supports a nuanced approach to ASA chemoprevention, tailoring treatment to each patient's genetic background, lifestyle factors, and risk profile. Ongoing research on dosage optimization and biomarker-driven selection is expected to further refine the integration of ASA into standard CRC prevention strategies.