Preventive agents in colorectal cancer

Abstract It is clear that despite improvements in many treatment modalities over the last 30 years, colorectal cancer remains a significant cause of morbidity and mortality. Once there is metastatic spread cure rates are very low, and even in relatively ‘early’ stage 3 disease, the long-term outcomes can be disappointing. It is therefore time to refocus efforts on prevention, rather than cure. Prevention can come in many forms so, for example, rigorous screening methodologies and national plans can interrupt the carcinogenic pathway by finding and resecting precancerous polyps. However, sensitivity of colonoscopy is not 100%, and there are costs and risks associated with this, which may be prohibitive in terms of a national anti-cancer prevention plan. Therefore, this chapter aims instead to look at possible low toxicity, low-cost agents that might help to prevent colorectal carcinogenesis either at a whole population-based level or segregated by CRC risk.