A good review on colorectal adenomas: WB Strum. NEJM 2016; 374: 1065.

A couple of points from review:

• There has been a wealth of new data in last 10 years.
• In 2016, ~134,000 persons in U.S. will be found to have colorectal cancer & 49.000 will die from it.
• Adenomas are present in 20-53% of the U.S. population older than 50 years of age.
• Adults in the U.S. have a lifetime risk of ~5% of adenocarcinoma.
• Two major pathways from adenomas to adenocarcinoma: chromosomal instability and micro satellite instability via predominantly ~25 genes.
• Screening interval recommendations (Table 1): 10 years for no polyps or juvenile polyps in rectum/sigmoid.
• Aspirin therapy may be beneficial but apply to persons who have no increased risk of bleeding and are willing to take low-dose aspirin (81 mg) daily.  The greatest benefit is expected in persons 50 to 59 years and a potential benefit in 60 to 69 years of age.
• Diets that are low in fat, regular physical exercise, maintenance of an appropriate body-mass index, and avoidance of smoking are recommended to lower risk.

Related full text article: Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: USPSTF Recommendations Excerpt:

“The USPSTF recommends initiating low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years. (B recommendation)The decision to initiate low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 60 to 69 years who have a 10% or greater 10-year CVD risk should be an individual one.”

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