Global 
Deutschland Colon to Rectum
Inflamm Bowel Dis. 2026;32(5):893-903
Low-dose ASA and the prevention of colorectal cancer in inflammatory bowel disease: A nationwide cohort study
Background: Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal cancer (CRC). However, the chemopreventive role of acetylsalicylic acid (ASA) remains uncertain due to conflicting findings in prior studies.
Methods: The study sought to evaluate the association between long-term ASA use and the risk of CRC and all-cause mortality in patients with IBD. We conducted a nationwide propensity score-matched cohort study using Taiwan’s National Health Insurance Research Database and Cancer Registry from 2008 to 2022. Time-dependent Cox models and Fine and Gray competing risk models were applied.
Results: Among 2743 matched ASA users and 2743 nonusers, ASA use was associated with reduced CRC risk (adjusted hazard ratio, 0.42; 95% confidence interval: 0.31–0.57) and lower all-cause mortality (adjusted hazard ratio, 0.66; 95% confidence interval: 0.58–0.74). A dose-response relationship was found for cumulative exposure, while optimal daily intensity was near 80 mg/d.
Conclusions: Long-term use of low-to-moderate-dose ASA was associated with reduced risks of CRC and mortality in patients with IBD. These findings support ASA’s potential as a chemopreventive agent and justify further randomized trials.
DOI: 10.1093/ibd/izaf304