Current concepts in colorectal cancer prevention

Abstract

Colorectal cancer chemoprevention, or chemoprophylaxis, is a drug-based approach to prevent colorectal cancer. Preventing colorectal adenomas with currently available agents demonstrates the promise of pharmacologic strategies directed at critical regulatory pathways. However, agent toxicity, lesion breakthrough and competing efficacy from endoscopy procedures challenge population-based implementation. This article reviews the role of colorectal cancer chemoprevention in the context of existing screening and surveillance guidelines and practice. Emphasis is placed on the role of the colorectal adenoma as a cancer precursor and its surrogacy in assessing individual risk and for evaluating chemoprevention efficacy. We discuss the importance of risk stratification for identifying subjects at moderate-to-high risk for colorectal cancer who are most likely to benefit from chemoprevention at an acceptable level of risk.

Keywords::

• adenoma
• chemoprevention
• colon cancer
• colonoscopy
• colonoscopy
• difluoromethylornithine
• NSAID
• polyps

Acknowledgements

Eugene Gerner acknowledges his long-time collaboration with Frank Meyskens, Director of the Chao Family Comprehensive Cancer Center at the University of California-Irvine. The authors acknowledge their many close collaborators at the University of Arizona and especially thank Cindy Thompson and Betsy Wertheim for their comments on the manuscript.

Financial & competing interests disclosure

Patricia Thompson and Eugene Gerner have been supported by numerous grants from the NIH. Major current support comes from NIH P30CA23074, P01CA41108 and P5095060. Eugene Gerner also has an ownership interest in Cancer Prevention Pharmaceuticals, Tucson, Arizona. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

Data from [7].

CRA Colorectal adenoma; CRC: Colorectal carcinoma.