Low-dose aspirin has a moderate chemopreventive effect on adenomas in the large bowel.

OLIC ACID AND ITS DERIVATIVES (folate) are essential nutrients in humans and play an important role in nucleotide synthesis and methylation reactions. 1 Folate deficiency leads to macrocytic anemia, and abundant evidence indicates that even in well-nourished western populations, folate supplementation reduces the risk of neural tube defects. 2 Considerable epidemiological evidence suggests that a low-folate diet is associated with an increased risk of colorectal neoplasia, 3-5 particularly in concert with alcohol, which can antagonize the metabolism of folate. 6,7 Much animal data support an antineoplastic effect of folate. However, in some animal studies, folate deficiency protects against, and supplementation increases, experimental carcinogenesis. 3 For editorial comment see p 2408.

The Multi-Society Task Force, in collaboration with invited experts, developed guidelines to assist health care providers with the appropriate provision of genetic testing and management of patients at risk for and affected with Lynch syndrome as follows: Figure 1 provides a colorectal cancer risk assessment tool to screen individuals in the office or endoscopy setting; Figure 2 illustrates a strategy for universal screening for Lynch syndrome by tumor testing of patients diagnosed with colorectal cancer; Figures 3,4,5,6 provide algorithms for genetic evaluation of affected and at-risk family members of pedigrees with Lynch syndrome; Table 10 provides guidelines for screening at-risk and affected persons with Lynch syndrome; and Table 12 lists the guidelines for the management of patients with Lynch syndrome. A detailed explanation of Lynch syndrome and the methodology utilized to derive these guidelines, as well as an explanation of, and supporting literature for, these guidelines are provided.

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