Chemoprevention of colorectal neoplasia: advances and controversies (the COX-2 story)

Abstract

Purpose of review: Colorectal cancer is prevalent, deadly and expensive to treat. Chemoprevention provides an opportunity to prevent colorectal cancer through prevention of precursor adenomas.

Recent findings: Three prospective randomized trials demonstrate significant reductions in new sporadic adenoma formation in individuals taking COX-2 selective inhibitors compared to placebo, but with an associated increase in cardiovascular risk.

Summary: Chemoprevention of colorectal adenomas with COX-2 selective nonsteroidal anti-inflammatory drugs is feasible, but these agents are unlikely to be used routinely for prevention of sporadic adenomas due to associated cardiovascular risk. Their use in other groups will depend on the answers to several questions regarding mechanisms of action and risk versus benefit.