USPSTF Supports Aspirin for Colorectal Cancer Prevention

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The United States Preventive Services Task Force (USPSTF) recently issued a draft recommendation advising the use of aspirin to prevent cardiovascular disease and colorectal cancer in certain patients aged 50 to 69 years.

The USPSTF found that taking aspirin can help 50- to 69-year-olds who are at increased risk of cardiovascular disease prevent heart attacks and stroke, as well as help prevent colorectal cancer, if taken for at least 10 years.

According to a press release, the USPSTF approached this recommendation in a new way.

“Each person has only one decision to make-whether or not to take aspirin for prevention,” says task force member Douglas K. Owens, MD, MS. “To help individuals and their clinicians make this decision, the task force integrated the evidence about the use of aspirin to prevent cardiovascular disease and colorectal cancer into one recommendation on the use of aspirin.”

The draft recommended that adults aged 50 to 59 years use low-dose aspirin for primary prevention of cardiovascular disease and colorectal cancer who have a 10% or greater 10-year risk for cardiovascular disease, are not at an increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for 10 years. This was a B grade recommendation.

In adults aged 60 to 69 years, the USPSTF said individuals with more than a 10% 10-year cardiovascular disease risk must make individual decisions about whether or not to use aspirin for prevention. This C grade level recommendation stated that a greater benefit would be seen among people who are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.

In adults younger than 50 and older than 70, the USPSTF said there is not enough evidence to assess whether the benefits of aspirin to prevent cardiovascular disease and colorectal cancer outweigh the harms.

To develop to these recommendations, the USPSTF commissioned three systemic evidence reviews and a decision analysis model. The primary studies included for all three reviews focused on primary prevention of cardiovascular disease. Specifically, the review included 11 randomized clinical trials looking at aspirin to prevent cardiovascular events published since the last USPSTF review in 2009. The review also included three trials evaluating primary and secondary cardiovascular disease that reported a 40% reduction in colorectal cancer incidence with the use of aspirin; however, this benefit was only seen after at least 5 to 10 years of aspirin use.

Commenting on the draft recommendation, Andrew T. Chan, MD, MPH, program director for the gastroenterology training program at Massachusetts General Hospital and associate professor of medicine at Harvard Medical School, called it a step in the right direction.

“First, it acknowledges the substantial body of evidence that has accumulated to date that aspirin reduces the risk of colorectal cancer,” Chan said. “Second, it recognizes that the decision to take aspirin is complex, requiring an appreciation of not only its benefits against colorectal cancer but also its role in cardiovascular disease prevention and its potential hazards. Taking into account all of these factors is challenging but necessary for any recommendation to make sense in clinical practice.”

This draft recommendation is open for public comment until October 12.