Aspirin in the Prevention of Colorectal Neoplasia

Annu Rev Med. 2021 Jan 27;72:415-430. doi: 10.1146/annurev-med-060319-120913. Epub 2020 Oct 9.


High-quality evidence indicates that regular use of aspirin is effective in reducing the risk for precancerous colorectal neoplasia and colorectal cancer (CRC). This has led to US and international guidelines recommending aspirin for the primary prevention of CRC in specific populations. In this review, we summarize key questions that require addressing prior to broader adoption of aspirin-based chemoprevention, review recent evidence related to the benefits and harms of aspirin use among specific populations, and offer a rationale for precision prevention approaches. We specifically consider the mechanistic implications of evidence showing differences in aspirin's effects according to age, the potential role of modifiable mechanistic biomarkers for personalizing prevention, and emerging evidence that the gut microbiota may offer novel aspirin-associated preventive targets to reduce high-risk neoplasia.

Keywords: chemoprevention; colorectal cancer; nonsteroidal anti-inflammatory drugs; personalized medicine; precision chemoprevention.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Aspirin / therapeutic use*
  • Chemoprevention / methods
  • Colorectal Neoplasms / prevention & control*
  • Humans
  • Precision Medicine / methods


  • Anti-Inflammatory Agents, Non-Steroidal
  • Aspirin