The short answer
In 2022 the USPSTF removed colorectal cancer prevention from its aspirin recommendation, concluding the evidence is unclear. It now advises against starting aspirin for prevention at age 60 or older.
In April 2022 the USPSTF removed colorectal cancer from its aspirin recommendation, concluding that "the evidence is unclear whether aspirin use reduces the risk of colorectal cancer incidence or mortality."
For adults aged 60 and older, the USPSTF now recommends against starting low-dose aspirin for primary prevention (grade D). For adults 40 to 59 with at least 10% ten-year cardiovascular risk, it is an individual decision (grade C).
The ASPREE trial randomized 19,114 mostly older adults to 100 mg aspirin daily or placebo; follow-up published in 2026 found no reduction in cancer incidence and a 15% higher risk of cancer-related death in the aspirin group (HR 1.15, 95% CI 1.03 to 1.29).
Aspirin raises the risk of gastrointestinal bleeding, bleeding in the brain and hemorrhagic stroke, and that risk climbs with age.
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The full explanation.
The claim
A daily low-dose aspirin prevents colorectal cancer, so healthy adults should take one.
What changed in 2022
For years the US Preventive Services Task Force recommended low-dose aspirin. Part of the reason was that it seemed to prevent colorectal cancer. In April 2022 the Task Force dropped that reason. Its current statement covers heart disease only. Colorectal cancer was taken out of the recommendation. The Task Force concluded that the evidence is unclear on whether aspirin use reduces the risk of colorectal cancer incidence or mortality.
The current grades matter here. Take adults aged 40 to 59 whose ten-year cardiovascular risk is 10% or higher. For them, starting low-dose aspirin is an individual decision to make with a clinician. For adults aged 60 and older, the Task Force recommends against starting aspirin for primary prevention. At that age the bleeding harms outweigh the benefit.
So if a headline tells you healthy older adults should take aspirin to prevent colon cancer, it is out of date.
What the evidence shows
Older observational studies watched people over time. Long-term follow-up of heart trials did the same. Both suggested that several years of daily aspirin lowered colorectal cancer rates. NCI's patient summary still reflects that earlier literature. Newer randomized data pointed the other way.
ASPREE randomized 19,114 adults to 100 mg of aspirin daily or a placebo. Most of them were aged 70 and older. Follow-up published in 2026 had a median of 8.6 years. It found no reduction in cancer incidence overall, by stage at diagnosis or by cancer type, including colorectal cancer. Cancer-related mortality, though, was 15% higher in the aspirin group. The authors summed it up this way: over a median of 8.6 years, low-dose aspirin was not associated with incident cancer among older adults, but cancer mortality risk was significantly elevated.
Do not start daily aspirin on the strength of a trial result. Aspirin causes bleeding in some people, and whether it suits you is a decision for your own doctor.
Aspirin's harms are not theoretical. It raises the risk of bleeding in the stomach and intestines. It raises the risk of bleeding in the brain, and of hemorrhagic stroke, which is a stroke caused by bleeding. That risk climbs steadily with age. That is exactly why the balance tips at 60.
Where aspirin still has a role
Two situations are different. They should not be lumped in with the general advice.
The first is Lynch syndrome, an inherited condition that sharply raises colorectal cancer risk. In the CAPP2 randomized trial, long-term daily aspirin reduced colorectal cancers in this group. Specialist guidelines discuss aspirin for these patients as a prescribed, individualized decision.
The second is people who have already had a heart attack, stroke or stent. That is secondary prevention. It is a different question with a different answer, and the 2022 statement does not apply to it.
What this does not mean
It does not mean aspirin is dangerous for everyone. And it is not a signal for anyone to stop taking it on their own. Stopping aspirin suddenly after a cardiovascular event can be harmful. That is why the conversation belongs with the clinician who prescribed it.
It also does not mean colorectal cancer cannot be prevented. It can. Screening on schedule finds and removes precancerous polyps, the small growths that can turn into cancer. That means colonoscopy or a stool-based test, starting at age 45 for people at average risk. It is the step with the strongest evidence behind it, and it is available to you now.
The bottom line
For most healthy adults, daily aspirin is no longer recommended as a way to prevent colorectal cancer. The evidence that it helps is unclear. The bleeding risk is real, and it grows with age. And the official guidance changed in 2022. Whether aspirin belongs in your life is a decision to reach with your clinician. You weigh your heart risk, your bleeding risk, and any inherited cancer syndrome in your family.
When to get help sooner
Aspirin's main harm is bleeding, and a few of its signs cannot wait.
- Call 911 or go to an emergency department if you vomit blood or something that looks like coffee grounds, or your stool is black and tarry or streaked with fresh blood. Those are signs of bleeding in the digestive tract (MedlinePlus).
- Call 911 or go to an emergency department if one side of your face droops, an arm or leg goes weak, your speech slurs, or a headache arrives suddenly and is the worst you have known. Aspirin raises the risk of bleeding in the brain, and stroke care is judged in minutes.
- Call your care team the same day if you bruise far more easily than before, your gums bleed when you brush, or a nosebleed keeps restarting.
- Call your care team within a day or two if you want to start or stop aspirin. Do not stop on your own after a heart attack, stroke, or stent.
Sources
- USPSTF final recommendation statement announcement (April 2022)
- NCI: Colorectal Cancer Prevention (PDQ) - patient version
- Cancer Incidence and Mortality With Aspirin in Older Adults: Follow-Up of the ASPREE Trial, JAMA Oncology (2026) — PubMed
- USPSTF: Colorectal Cancer Screening
- MedlinePlus: Gastrointestinal Bleeding
Words to know
Tap any term to see what it means.
Common questions
Does the USPSTF still recommend aspirin to prevent colorectal cancer?
No. Colorectal cancer prevention was removed from the recommendation in April 2022. The current statement covers cardiovascular disease only, and the Task Force concluded the evidence is unclear on whether aspirin reduces colorectal cancer incidence or mortality.
Why did the recommendation change?
Newer randomized evidence and longer follow-up did not support the earlier benefit. In particular, the ASPREE trial in older adults found no reduction in cancer incidence, and higher cancer mortality among participants who developed cancer. At the same time the bleeding harms of aspirin became clearer, especially after age 60.
I have been taking a daily aspirin for years. Should I stop?
That is a question for your clinician, not something to decide from an article. Stopping aspirin can be harmful for people taking it after a heart attack, stroke or stent. Bring the reason you started, your bleeding history and your heart risk to your next visit and decide together.
Is there anyone for whom aspirin does help prevent colorectal cancer?
Yes. People with Lynch syndrome, an inherited condition that sharply raises colorectal cancer risk, had fewer colorectal cancers on long-term daily aspirin in the CAPP2 randomized trial, and specialist guidelines discuss aspirin for this group. That is a prescribed, individualized decision with a genetics or gastroenterology team.
What actually lowers colorectal cancer risk?
Screening, most of all. Colonoscopy and stool-based tests, starting at age 45 for people at average risk, find and remove precancerous polyps before they become cancer. Not smoking, limiting alcohol, staying active and eating more fiber all help too.
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Written by: Cancer ExplainedSources last checked: 2026-08-13 what this meansLast updated: 2026-08-19Next planned review: 2027-01-30
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How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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