Colorectal cancer chemoprevention – the role of mesalazine

Colorectal cancer is a disease with a high incidence and mortality due to the late diagnosis. The mortality in patients diagnosed with colorectal cancer in the setting of inflammatory bowel disease (IBD) is higher than for sporadic colorectal cancer. The risk for colorectal cancer in IBD is related to the duration and anatomic extent of the disease. Attention is therefore focused on prevention in some patients. Endoscopic polypectomy has been shown to reduce the incidence of sporadic cancer. There is also indirect evidence to suggest that surveillance colonoscopy is beneficial for patients with IBD. Epidemiological studies have shown that individuals reporting a regular intake of acetylsalicylic acid and other non-steroidal anti-inflammatory drugs have a reduced risk of developing colorectal polyps and cancer. Similarly, in patients with IBD maintenance mesalazine reduces the risk of neoplastic progression. In this article, we review the evidence regarding selected agents for chemopreventive strategies in sporadic colorectal cancer, and the value of chemoprevention of colorectal cancer with 5-ASA in IBD.