The American Cancer Society (ACS) estimates 151,030 new cases and 52,580 deaths from colorectal cancer (CRC) in 2022; it is the third most commonly diagnosed cancer in women and men (Siegel, Miller, Fuchs, & Jemal, 2022). Fortunately, these numbers have steadily declined thanks to increased uptake of CRC screening, polyp removal, and earlier diagnosis and treatment (ACS, 2020). Modifiable risk factors for CRC cause over half of cases and deaths (Siegel, Miller, & Jemal, 2020). These include healthy dietary choices, physical activity, weight control, and abstinence from tobacco and alcohol (Rock et al., 2020).
Chemoprevention of Colorectal Cancer
Chemoprevention of CRC by use of aspirin has long been studied. The US Preventive Services Task Force (USPSTF) first recommended low-dose aspirin for the possible reduction of CRC in 2016 (Bibbins-Domingo, 2016).
The utility of low-dose aspirin to reduce CRC incidence and mortality was studied further, as were the potential harms. Chief among the harms are gastrointestinal bleeding, intracranial hemorrhage, and hemorrhagic stroke. The USPSTF (2022) assessed these risks and benefits related to the chemoprevention of CRC. Their conclusion is the evidence is unclear whether the incidence or mortality of CRC is reduced. For this reason, the recommendations for chemoprevention of CRC were removed from their 2022 update. Further, they limited the 2016 recommendations for primary prevention of cardiovascular disease (CVD).
Primary Prevention of Cardiovascular Disease: 2022 Recommendations
The USPSTF (2022) determined the addition of low-dose aspirin for primary prevention of CVD should be individualized for patients between 40 and 59 years. The current data support a small benefit to those patients who are not at risk of bleeding and have a 10% or greater 10-year CVD risk. The 10-year CVD risk can be determined by the Atherosclerotic Cardiovascular Disease Risk Calculator (American Heart Association, 2018). This is a "C recommendation," which means "selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small." The suggestion for practice is to "offer or provide this service for selected patients depending on individual circumstances" (USPSTF, 2018).
The other recommendation by the USPSTF (2022) is against the addition of low-dose aspirin for primary prevention of CVD for patients 60 years and older. This is a "D recommendation," which means "recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits." The suggestion for practice is to "discourage the use of this service" (USPSTF, 2018).
Implications for Practice
The gastroenterology nurse sees many patients for CRC screening and a variety of gastroenteric conditions. This population may have been started on low-dose aspirin for CVD prevention or CRC chemoprevention. The updated and more restricted USPSTF (2022) recommendations should be used to guide their treatment.
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