Title Chemoprophylaxis in colorectal cancer: Current concepts and a practical algorithm for use

Background: Colorectal cancer (CRC) is the second most common lethal cancer in the Western world. There is a 10 to 20 years lead time from normal mucosa to carcinoma which offers a window of opportunity to modify and prevent the outcome of CRC, with its incipient morbidity and mortality. Objective: To review the evidence for chemoprophylaxis in CRC, identify currently utilized agents and determine their role in the current management algorithm of CRC. Methods: Review of large cohort-control and randomized controlled trials in the most studied chemoprophylaxis agents. Results/conclusion: Currently, the role for chemoprophylaxis in CRC remains a niche area, celecoxib is the only recommended agent for utilization in patients with familial polyposis syndromes. However, the role of chemoprophylaxis is likely to grow significantly in the next decade as understanding of the stepwise tumorigenesis cascade becomes better understood and currently conducted clinical trials are completed.