The role of NSAIDs in the prevention of colon cancer.

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Abstract
The treatment of colorectal cancer continues to improve, but it still remains the second leading cause of cancer-related death in the United States. In 2001, there will be over 135,000 new cases of colorectal cancer in the United States alone. Prevention is not only a realistic option for colon cancer, but also one that offers significant hope for this dreadful disease. Cancer prevention is concerned with the identification of preventable causes of cancer in a target population and with the effective application of strategies to reduce its incidence. Prevention may be categorized as primary, secondary, or tertiary. Primary prevention modifies genetic, environmental, and biological factors etiological in a given tumor to alter their effects on tumorigenesis. For example, elimination of chemicals, radiation, and viruses constitutes primary prevention. Unfortunately, culprit agents, e.g., smoking, are rarely identified. Secondary prevention deals with screening for premalignant and early neoplastic lesions, symptomatic or asymptomatic, and their expeditious treatment. Screening a large population becomes worthwhile if the disease represents a significant health problem, and a cost-effective treatment is available and acceptable to patients and doctors. For example, screening for colorectal cancer reduces mortality by 15–33%. Tertiary prevention utilizes specific pharmacological agents or nutrients to prevent, delay, or retard the development of cancer. This is also called chemoprevention. Nonsteroidal antiinflammatory drugs (NSAIDs) are emerging as the prototypical chemopreventive agents against colorectal cancer, a notion now supported by a considerable body of epidemiological, animal, and basic science data. In this review, we summarize our current understanding of the role of NSAIDs in the prevention of colorectal cancer and present efforts to develop safer alternatives to traditional NSAIDs.