Structured Abstract

Contents

• [Preface]
• Abbreviations
• 1. Introduction
  • Scope and Purpose
  • Condition Definition
  • Prevalence and Burden of Disease
  • Etiology and Natural History
  • Risk Factors
  • Interventions to Prevent Colorectal Cancer
  • Molecular Mechanism of Action for Aspirin in Colorectal Cancer Prevention
  • Current Clinical Practice and Recommendations of Other Groups
  • Previous USPSTF Recommendation
• 2. Methods
  • Analytic Framework and Key Questions
  • Data Sources and Searches
  • Study Selection
  • Quality Assessment
  • Data Abstraction
  • Data Synthesis and Analysis
  • Expert Review and Public Comment
  • USPSTF Involvement
• 3. Results
  • Literature Search
  • Overall Body of Evidence
  • KQs 1 and 3 Does Regular Aspirin Use Reduce Colorectal Cancer Mortality or All-Cause Mortality in Adults Without a History of Colorectal Cancer, Familial Adenomatous Polyposis, or Lynch Syndrome?
  • KQ 4 Does Regular Aspirin Use Reduce the Incidence of Colorectal Cancer in Adults Without a History of Colorectal Cancer, Familial Adenomatous Polyposis, or Lynch Syndrome?
  • KQ 5 Does Regular Aspirin Use Reduce the Incidence of Colorectal Adenoma in Adults Without a History of Colorectal Cancer, Familial Adenomatous Polyposis, or Lynch Syndrome?
  • KQ 7 What Are the Harms of Regular Aspirin Use for the Prevention of Colorectal Cancer (i.e., at the Dosage and Duration Required to Achieve a Preventive Health Effect) in Adults Without a History of Colorectal Cancer, Familial Adenomatous Polyposis, or Lynch Syndrome?
  • Contextual Question What Is the Level of Persistence of Aspirin Use Among Adults Who Initiate a Regimen for the Prevention of Colorectal Cancer?
• 4. Discussion
  • Summary of Evidence
  • Other Systematic Reviews
  • Limitations of the Review and Future Research Needs
  • Applicability of Findings to Clinical Practice
  • Conclusion
• References
• Appendix A Literature Search Strategies
• Appendix B Ongoing or Recently Completed Studies
• Appendix C Excluded Studies
• Appendix D Characteristics of Included Studies

Acknowledgments: The authors acknowledge the following individuals for their contributions to this project: Robert McNellis, MPH, PA, for project oversight on behalf of AHRQ; current and former members of the U.S. Preventive Services Task Force who contributed to topic deliberations; Daphne Plaut, MLS, and Smyth Lai, MLS, for designing and conducting the literature searches; and Susan Brandzel, MPH, Lisa Shulman, MSW, Karen Wernli, PhD, Chris Tachibana, PhD, Nora Henrikson, PhD, MPH, Gabrielle Gundersen, BA, Brittany Burda, MPH, Caitlyn Senger, MPH, Tracy Beil, MS, and Arika Wieneke.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services¹, Contract No. HHSA-2900-2012-00015-I, Task Order No. 2. Prepared by: Kaiser Permanente Research Affiliates Evidence-based Practice Center²

Suggested citation:

Chubak J, Kamineni A, Buist DS, Anderson ML, Whitlock EP. Aspirin Use for the Prevention of Colorectal Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 133. AHRQ Publication No. 15-05228-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2015.

This report is based on research conducted by the Kaiser Permanente Research Affiliates Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-2900-2012-00015-I, Task Order No. 2). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

1

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov

2

Kaiser Permanente Center for Health Research, Portland, OR