CRC chemoprv

1. Kurdistan Board GEH/GIT Surgery J Club 2021
Supervised by Professor Dr. Mohamed Alshekhani.

2. Introduction:
 CRC is the second leading causeof cancer death in U/S, but incidence&
mortality have both steadily declined since the 1980s.
 These encouraging trends have been attributed to a combination of
increased CRC screening&pop-level red in lifestyle RFs such as smoking.
 There is longstanding interest in the use of medications to lower CRC risk,
known as chemoprevention.
 The evidence is summarized& offer BPA on chemoprevention against CR
neoplasia for the most well-studied&commonly prescribed medications
that have been assessed in RCTs: aspirin, non-aspirin NSAIDs,
metformin, calcium,vitamin D, folic acid& statins.
 There is need for more robust trial data on metformin.
 Future studies are also expected to clarify the effect of vitamin D on CRC
incidence& mortality.
 Additional trials evaluating the combination of multiple medications
should be pursued because they may uncover synergistic effects.
 Chemopr is adjunctive to screening&lifestyle factors to prevent CRC.

6. Conclusion:
 This clinical practice update summarizes the evidence for the most widely
studied agents for chemoprevention of colorectal neoplasia in average-risk
individuals
 The ideal chemopreventive agent should be inexpensive,effective& safe
when used on a population level&few medications meet all these criteria.
 There is strong evidence to support the use of aspirin for the
chemoprevention of colorectal neoplasia for individuals who are younger,
at risk for CVD&not at high risk for bleeding.
 Evidence for metformin appears consistent in observational studies& in a
single trial.
 Non-aspirin NSAIDs, calcium, vitamin D, folic acid&statins currently do
not have a role as chemopreventive agents for colorectal neoplasia because
of either adverse events or lack of efficacy.
 The scope of this review excluded patients with hereditary syndromes such
as FAP or Lynch syndrome.