March is Colorectal Cancer Awareness Month, so grab your prep kit and let’s get ready to talk about colorectal health

Let’s look at some recent statistics. According to the National Institute for Occupational Safety and Health (NIOSH), firefighters have a 9% higher risk of being diagnosed with cancer and a 14% higher risk of cancer-related mortality compared to the general population. 

A meta-analysis by Jahnke et al. (2024) reveals firefighters face a 19% higher risk of colorectal cancer (CRC) than the general population. Occupational risks and lifestyle challenges first responders face contribute to this increased vulnerability. The American Cancer Association (ACA) also noted that CRC is trending upwards in younger adults. 

Colorectal cancer, often referred to as the “silent killer,” can develop without noticeable symptoms until it reaches an advanced stage, making early detection through regular screening even more crucial for firefighters.

What is Colorectal Cancer?

Colorectal cancer occurs in the large intestine (colon), typically starting as small, benign polyps that can become cancerous over time. It’s one of the most common cancers worldwide, but also one of the most preventable when caught early. Once CRC has been diagnosed, it will be staged for appropriate management. The stages include:

• Polyp stage is an abnormal growth of tissue in the colon or rectum. While not all polyps are cancerous, it’s impossible to predict which ones will eventually develop into cancer. Removing polyps early through screenings is crucial because it helps prevent the progression to cancer.
• Stage I: The cancer has invaded, but not through, the entire wall of the intestine. It is confined to the inner layers of the colon or rectum and has not spread to nearby tissues or lymph nodes.
• Stage II: The cancer has invaded through the entire wall of the intestine but has not spread to nearby lymph nodes or distant organs.
• Stage III: The cancer has spread to nearby lymph nodes, but whether it has invaded the full thickness of theintestinal wall may vary. This stage suggests the cancer is more advanced but may still be treatable through surgery and/or chemotherapy.
• Stage IV: The cancer has spread, or metastasized, to distant organs such as the liver, lungs, or other parts of the body. This stage indicates advanced cancer and often requires a combination of treatments, including surgery, chemotherapy, and sometimes targeted therapy.

Colorectal Cancer Risk Factors

• Personal history: You have previously been diagnosed with CRC or adenomatous polyps
• Family history: Having a single affected first-degree relative (parent, sibling, or child) with СRC increases the risk approximately twofold
• Inflammatory bowel disease: History of ulcerative colitis, Crohn’s disease, C-diff infection
• Abdominopelvic radiation
• Cystic fibrosis
• Race and sex: Black Americans, Native Americans and Alaskan Native individuals have the highest incidence and mortality rates for CRС of all racial and ethnic groups in the United States
• Obesity
• Diabetes mellitus and insulin resistance
• Red and processed meat: Although the data is not entirely consistent, long-term consumption of red meat or processed meats appears to be associated with an increased risk of CRC
•  Tobacco use
• Alcohol: 29% higher risk of CRC with moderate alcohol consumption of 2-3 drinks/day
• Carcinogen exposure: Polycyclic aromatic hydrocarbons (PAHs), diesel exhaust and other toxins increase cancer risk
• Lifestyle factors: Shift work, irregular meals, stress and limited access to nutritious food contribute to unhealthy digestive systems 

Firefighters face unique occupational risk factors. By understanding these factors, you can take targeted steps to protect yourself.

Colorectal Cancer Protective Factors

The good news is, there are several things you can do to help protect yourself from developing CRC. These include:

• Regular physical activity
• Eating a diеt high in fruits, vegetables and whole grains
• Maintaining a healthy weight
• Reducing or eliminating the amount of alcohol you consume
• Stop smoking and stop using tobacco products
• Perimenopausal and post-menopausal hormone therapy (of both combined еstrоgen plus progestin and unopposed еstrοgeո) has been linked to a reduced risk of СRС
• Have regular screenings for early detection
• Do your PPE decon
• Shower after exposure to harmful chemicals and toxins
• Practise good sleep hygiene

Recognizing Symptoms of Colorectal Cancer

While many cases are asymptomatic, keep an eye out for these warning signs:

• Persistent changes in bowel habits (diarrhea, constipation, or narrowing stools) are most common
• Blood in stool or rectal bleeding
• Abdominal pain
• Iron deficiency anemia
• Abdominal or rectal mass
• Feeling weak or tired

Make an appointment with your primary care provider or your gastrointestinal healthcare provider if you have any of these symptoms.

Screening Recommendations

Colorectal cancer often develops silently, with few noticeable symptoms until it’s advanced. Early detectionthrough screening can dramatically improve outcomes, increasing survival rates and minimizing the need for invasive treatments.

When and How to Get Screened

• Start Screening at 45: This is the standard recommendation from the United States Preventive Services Task Force (USPSTF) for average-risk individuals
• Earlier for High-Risk Groups: If you have a family history or other risk factors such as being a first responder, talk to your healthcare provider about getting screened sooner

Screening Methods

• Colonoscopy: Performed every 10 years for average risk. The most thorough option, allowing forboth lesion detection and removal of polyps. A biopsy may be performed during colonoscopy to confirm a diagnosis
• Fecal Tests: Annual stool based, non-invasive options like FOBT, FIT, or DNA-based tests like Cologuardcollected in your home. If the screening test is positive for hemoglobin in your stool, a colonoscopy is recommended next

Overcoming Scheduling Challenges

Firefighters often face challenges in scheduling routine medical appointments due to their demanding and unpredictable work schedules. To address this, it’s crucial to proactively co-ordinate with your fire department to schedule appointments during periods of downtime, especially for procedures like colonoscopies that require significant preparation. 

A minimum of 48 hours should be allocated for bowel preparation and the procedure itself, and proximity to bathroom facilities during the prep phase is essential. Advocating for department-wide health initiatives can help prioritize and normalize preventative screenings, as well.

Bowel Prep

Your gastrointestinal healthcare provider will give you specific medication instructions to follow for fully cleansing your bowels. This is a critical step! The more cleaned out you are, the more accurate your colon exam willbe, so drink up! To make the drink more palatable you can try the following:

• Use a straw
• Chill the solution

Follow this link for more helpful prep tips.

Emotional Support Matters

Receiving a diagnosis can be overwhelming. Peer support within the firehouse and open communication with family and friends can make a significant difference.

CRC Treatment Options

Colon cancer treatment depends on the stage and location of the cancer:

• Surgery: Often the first line of treatment for removing cancerous tissue
• Chemotherapy and radiation: Used for advanced cases or to prevent recurrence
• Targeted therapy: Newer treatments that attack cancer cells while sparing healthy ones

Leveraging Firefighter Strengths

Physical fitness is a cornerstone of firefighting and it can aid in recovery. Staying active, within healthcare provider-approved limits, can help boost immunity, mood, and overall health. Equally vital is nutrition during treatment; working with a dietitian can help you optimize your energy levels and support your gut health, ensuring your body receives the necessary sustenance to withstand the rigors of therapy.

Colorectal Cancer: Addressing Mental Health

Chronic stress can compromise immune function, indirectly contributing to cancer risk. Building resilience throughmindfulness, counseling or peer support can benefit both your mental and physical health. Check in frequently on your fellow brothers and sisters. Offer gas cards, Meal Train, gift cards, lawn mowing, childcare, hotel rooms if treatments are far, fellowship, a shoulder to cry on, laughter and kindness.

Closing Thoughts

Leadership and peer support are vital in fostering a culture of health in the fire service. When officers advocate for and participate in screenings, they set a powerful example for their crews, making preventive care a shared priority. 

Peer encouragement helps normalize these conversations, creating a support network that extends beyond the fireground. Colon cancer doesn’t have to be a five-alarm fire, because early detection saves lives. By understanding risks, scheduling screenings and taking preventive steps, firefighters can protect their health. Call your doctor today to schedule your screening! There is no better time than now!