of all new cancers (1.2 million cases annually) and 8.1%
of all cancer mortality (1). Recognition of the efficacy of
endoscopic polypectomy in preventing CRC by identifying
and removing precancerous adenomas has led to a marked
increase in the use of colonoscopy screening, particularly in
the United States (2–4). However, the development of
primary prevention strategies to reduce the risk of developing
colorectal neoplasia remains an important goal,
particularly in view of the inherent limitations of population-based
secondary prevention programs that rely on
detection and removal of adenomas.
Perhaps the most widely studied pharmacologic agent
for the prevention of CRC in humans is aspirin. During
October 2 to 3, 2010, an International Expert Roundtable,
sponsored by Bayer, convened in Berlin, Germany to discuss
the evidence for aspirin’s role in CRC prevention. In
this overview, members of this Roundtable summarize
the meeting and discuss new data published through
September, 2011. We address a number of key issues,
including epidemiologic evidence of aspirin use in relation
to CRC incidence; clinical trials examining the role of
aspirin in prevention of CRC and adenoma; clinical trials
of aspirin in patients with hereditary syndromes; observational
studies of aspirin use in relation to survival among
patients with established CRC; safety issues associated
with long-term aspirin use; optimal dosing that balances