Current concepts in colorectal cancer prevention

Area of Science:

• Oncology
• Gastroenterology
• Preventive Medicine

Background:

• Colorectal cancer chemoprevention, or chemoprophylaxis, offers a drug-based strategy to prevent colorectal cancer.
• Pharmacologic agents targeting critical regulatory pathways show promise in preventing colorectal adenomas, which are precursors to colorectal cancer.

Purpose of the Study:

• To review the role of colorectal cancer chemoprevention within current screening and surveillance guidelines.
• To emphasize the significance of colorectal adenomas as cancer precursors and their utility in risk assessment and chemoprevention efficacy evaluation.
• To discuss risk stratification for identifying individuals most likely to benefit from chemoprevention.

Main Methods:

• Literature review of colorectal cancer chemoprevention strategies.
• Analysis of the role of colorectal adenomas as cancer precursors.
• Discussion of risk stratification for targeted chemoprevention.

Main Results:

• Currently available agents show promise in preventing colorectal adenomas.
• Agent toxicity, lesion breakthrough, and competing efficacy of endoscopic procedures present challenges for population-based implementation.
• Risk stratification is crucial for identifying individuals at moderate-to-high risk for colorectal cancer.

Conclusions:

• Colorectal cancer chemoprevention holds promise but faces implementation challenges.
• Colorectal adenomas serve as important surrogates for risk assessment and evaluating chemoprevention efficacy.
• Targeted chemoprevention based on risk stratification is essential for maximizing benefits and minimizing risks.