Occupational Medicine 2014;64:255–258 Advance Access publication 17 April 2014 doi:10.1093/occmed/kqu046
A workplace colorectal cancer screening program in firefighters: lessons learned J. M. E. Walsh1, M. B. Potter2, M. Arora1, G. Gildegorin3 and J. Terdiman4 1 Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, 1600 Divisadero Street, San Francisco, CA 94115, USA, 2Department of Family and Community Medicine, University of California at San Francisco, San Francisco, CA 94143, USA, 3Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA 94107, USA, 4Division of Gastroenterology, Department of Medicine, University of California at San Francisco, San Francisco, CA 94115, USA.
Background Although colorectal cancer (CRC) screening is widely recommended, screening rates remain low. Workplace interventions have the potential to increase rates of screening. Aims
To evaluate the impact of a workplace CRC screening program targeting active duty and retired firefighters.
Methods
A letter, a fecal immunochemical test (FIT) kit and a survey were mailed to all active duty and retired San Francisco firefighters aged 40 and older during 2008–09. The survey included questions about CRC risk factors and prior CRC screening tests. The primary outcome was return of the completed FIT.
Results
FIT kits and surveys were sent to 1203 firefighters. In total, 445 individuals (37%) completed the survey, and 400 (33%) completed the FIT. Forty-five per cent of respondents had had a stool test for blood at some time, although few (8%) had had it within the past year. Thirty-six per cent of respondents said they had had a sigmoidoscopy at some time, although only 15% had had it within the past 5 years and 37% within the past 10 years. Among those aged 50 and older, 59% had had a test for colon cancer at some time.
Conclusions A workplace intervention can increase CRC screening rates in firefighters. Future studies should focus on the long-term sustainability of this type of program. Key words
Cancer; colorectal cancer screening; firefighters; workplace health promotion.
Introduction In the USA, the US Preventive Services Task Force recommends colorectal cancer (CRC) screening for everyone aged 50–75 with either an annual stool-based test, a sigmoidoscopy every 5 years or a colonoscopy every 10 years [1], although screening rates remain suboptimal. In 2008, only 53% of eligible individuals had fecal occult blood testing in the last year or lower gastroin testinal endoscopy in the last 10 years [2]. Firefighters are exposed to many carcinogens and could be at increased risk for many diseases [3,4]. One study of Philadelphia firefighters suggested an increased CRC risk [5], whereas a study of firefighters in Washington State did not [6]. If there is an increased CRC risk in firefighters, it would be appropriate to modify screening
strategies accordingly. One strategy recommended by the US Multisociety Task Force on CRC screening for high-risk individuals (based on family history) is to start screening at age 40 [7]. Workplace screening can reach many people, especially those who do not see their physicians regularly. In 2008, the San Francisco Firefighters Cancer Prevention Foundation (SFFCPF) implemented a worksite CRC screening program. The purpose of this study was to evaluate the screening program and its outcomes.
Methods The SFFCPF implemented and funded a CRC screening program targeting all active duty and retired firefighters
© The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected]
Downloaded from http://occmed.oxfordjournals.org/ at Anadolu University on May 21, 2014
Correspondence to: J. M. E. Walsh, Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, 1600 Divisadero Street, San Francisco, CA 94115, USA. Tel: +1 415 353 9747; fax: +1 415 353 9890; e-mail: [email protected]
256 OCCUPATIONAL MEDICINE
aged 40 and older. SFFCPF chose screening starting at age 40 because of concerns that CRC risk may be increased in firefighters. A letter, fecal immunochemical test (FIT) and survey were mailed in 2008–09. The letter included CRC screening recommendations and advised subjects to talk with their own physicians about testing. The FIT kit included the stool card, collection device, instructions and a stamped envelope for participants to mail the completed kit to a laboratory, which provided and processed the tests. Test results were sent to the San Francisco Fire Department (SFFD) physician, who communicated results to participants and encouraged them to arrange appropriate follow-up with their physicians. Participants were asked about CRC risk factors
and prior screening tests, regardless of FIT completion. University of California at San Francisco researchers provided input into survey questions. A separate envelope was included for survey return. Respondents were entered into a raffle to receive one of three $100 gift certificates. The main outcome measure was FIT completion. Other outcomes included history of CRC screening and family history of CRC. Data were analyzed using SAS version 9.3 [8]. Descriptive statistics were computed for each outcome. We also calculated rates for individuals aged 50 and older. To assess any differences in screening among participants with family history, we used t-tests for continuous measures and chi-squared for categorical measures.
Has had test for colon cancera Yes No Not sure Has had stool test for blood Yes, within the last year Yes, more than a year ago No Not sure Has had sigmoidoscopyb Yes, within last 5 years Yes, >5 years ago Yes, but cannot remember when No Not sure Has had barium enema testc Yes, within last 5 years Yes, >5 years ago Yes, but cannot remember when No Not sure Has had colonoscopyd Yes, within last 10 years Yes, >10 years ago Yes, but cannot remember when No Not sure Has a first-degree relative with colon cancer Yes No For those with a relative, age of relativee 60
Total n = 442, n (%)
Age 40–49 n = 198, n (%)
Age 50 and older n = 244, n (%)
162 (37) 224 (51) 54 (12)
20 (10) 151 (76) 27 (14)
142 (59) 73 (30) 27 (11)
34 (8) 163 (37) 217 (49) 28 (6)
4 (2) 38 (19) 142 (72) 14 (7)
30 (12) 125 (51) 75 (31) 14 (6)
68 (15) 83 (19) 8 (2) 272 (62) 9 (2)
7 (4) 13 (7) 1 (1) 174 (88) 2 (1)
61 (25) 70 (29) 7 (3) 98 (40) 7 (3)
15 (3) 22 (5) 3 (1) 382 (87) 19 (5)
4 (2) 4 (2) 0 (0) 187 (94) 3 (2)
11 (5) 18 (7) 3 (1) 195 (80) 16 (7)
164 (37) 9 (2) 3 (1) 263 (60) 1 (1)
24 (12) 1 (1) 0 (0) 172 (87) 0 (0)
140 (57) 8 (3) 4 (2) 91 (37) 1 (1)
49 (11) 393 (89) (n = 48) 9 (19) 12 (25) 27 (56)
17 (9) 181 (91) (n = 17) 5 (29) 5 (29) 7 (41)
32 (13) 212 (87) (n = 31) 4 (13) 7 (23) 20 (65)
Two did not provide information about having a test for colon cancer. Two did not provide information about having a sigmoidoscopy. c One did not provide information about having a barium enema test. d One did not provide information about having a colonoscopy. e One did not provide information about age of relative. a
b
Downloaded from http://occmed.oxfordjournals.org/ at Anadolu University on May 21, 2014
Table 1. Responses to survey items by age groups for active duty and retired firefighters
J. M. E. Walsh ET AL.: COLORECTAL CANCER SCREENING PROGRAM IN FIREFIGHTERS 257
Results FIT kits and surveys were sent to 1203 firefighters and 498 responded (41%). Of those responding, 98% provided demographic information, 89% (442) completed the survey, 80% (400) completed the FIT and 69% (346) completed both the survey and the FIT. Of those providing a FIT, 6% (25) tested positive. The average age of respondents who provided demographic information was 53 + 10; 89% (419) were male. Of the 286 who provided ethnic information, 58% (164) were white, 7% were African-American, 11% were Latino, 18% were Asian/Pacific Islander and 6% were another ethnicity.
Survey responses are described in Table 1. Approximately half had not had prior CRC screening. Forty-five per cent had had a stool test for blood at some time, although few (8%) were up to date. About a third stated that they had had a sigmoidoscopy, although only 15% were up to date. About a third of participants had had a colonoscopy within the past 10 years. Among individuals aged 50 and older, 59% had completed a previous CRC test, 12% had had a stool test in the past year, 25% had had a sigmoidoscopy in the past 5 years and 57% within the last 10 years. As expected, rates of previous screening tests were higher in those aged 50 and older. Eleven per cent of respondents had a
Variable
No family history n = 436
Family history n = 49
P-value
Age, years, mean ± standard deviation Gender, n (%)a Male Female Ethnicity, n (%) White African-American Latino Asian/Pacific Islander Other Unknown Test for colon cancer, n (%) Yes No Not sure Stool test for blood, n (%) Yes, more than a year ago Yes, within the last year No Not sure Sigmoidoscopy, n (%) Yes, >5 years ago Yes, within last 5 years Yes, but cannot remember when No Not sure Barium enema test, n (%) Yes, >5 years ago Yes, within last 5 years Yes, but cannot remember when No Not sure Colonoscopy, n (%) Yes, >10 years ago Yes, within last 10 years Yes, but cannot remember when No/not sure
53 ± 10
55 ± 10
NS
386 (89) 49 (11)
47 (98) 1 (2)
A workplace colorectal cancer screening program in firefighters: lessons learned J. M. E. Walsh1, M. B. Potter2, M. Arora1, G. Gildegorin3 and J. Terdiman4 1 Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, 1600 Divisadero Street, San Francisco, CA 94115, USA, 2Department of Family and Community Medicine, University of California at San Francisco, San Francisco, CA 94143, USA, 3Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA 94107, USA, 4Division of Gastroenterology, Department of Medicine, University of California at San Francisco, San Francisco, CA 94115, USA.
Background Although colorectal cancer (CRC) screening is widely recommended, screening rates remain low. Workplace interventions have the potential to increase rates of screening. Aims
To evaluate the impact of a workplace CRC screening program targeting active duty and retired firefighters.
Methods
A letter, a fecal immunochemical test (FIT) kit and a survey were mailed to all active duty and retired San Francisco firefighters aged 40 and older during 2008–09. The survey included questions about CRC risk factors and prior CRC screening tests. The primary outcome was return of the completed FIT.
Results
FIT kits and surveys were sent to 1203 firefighters. In total, 445 individuals (37%) completed the survey, and 400 (33%) completed the FIT. Forty-five per cent of respondents had had a stool test for blood at some time, although few (8%) had had it within the past year. Thirty-six per cent of respondents said they had had a sigmoidoscopy at some time, although only 15% had had it within the past 5 years and 37% within the past 10 years. Among those aged 50 and older, 59% had had a test for colon cancer at some time.
Conclusions A workplace intervention can increase CRC screening rates in firefighters. Future studies should focus on the long-term sustainability of this type of program. Key words
Cancer; colorectal cancer screening; firefighters; workplace health promotion.
Introduction In the USA, the US Preventive Services Task Force recommends colorectal cancer (CRC) screening for everyone aged 50–75 with either an annual stool-based test, a sigmoidoscopy every 5 years or a colonoscopy every 10 years [1], although screening rates remain suboptimal. In 2008, only 53% of eligible individuals had fecal occult blood testing in the last year or lower gastroin testinal endoscopy in the last 10 years [2]. Firefighters are exposed to many carcinogens and could be at increased risk for many diseases [3,4]. One study of Philadelphia firefighters suggested an increased CRC risk [5], whereas a study of firefighters in Washington State did not [6]. If there is an increased CRC risk in firefighters, it would be appropriate to modify screening
strategies accordingly. One strategy recommended by the US Multisociety Task Force on CRC screening for high-risk individuals (based on family history) is to start screening at age 40 [7]. Workplace screening can reach many people, especially those who do not see their physicians regularly. In 2008, the San Francisco Firefighters Cancer Prevention Foundation (SFFCPF) implemented a worksite CRC screening program. The purpose of this study was to evaluate the screening program and its outcomes.
Methods The SFFCPF implemented and funded a CRC screening program targeting all active duty and retired firefighters
© The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected]
Downloaded from http://occmed.oxfordjournals.org/ at Anadolu University on May 21, 2014
Correspondence to: J. M. E. Walsh, Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, 1600 Divisadero Street, San Francisco, CA 94115, USA. Tel: +1 415 353 9747; fax: +1 415 353 9890; e-mail: [email protected]
256 OCCUPATIONAL MEDICINE
aged 40 and older. SFFCPF chose screening starting at age 40 because of concerns that CRC risk may be increased in firefighters. A letter, fecal immunochemical test (FIT) and survey were mailed in 2008–09. The letter included CRC screening recommendations and advised subjects to talk with their own physicians about testing. The FIT kit included the stool card, collection device, instructions and a stamped envelope for participants to mail the completed kit to a laboratory, which provided and processed the tests. Test results were sent to the San Francisco Fire Department (SFFD) physician, who communicated results to participants and encouraged them to arrange appropriate follow-up with their physicians. Participants were asked about CRC risk factors
and prior screening tests, regardless of FIT completion. University of California at San Francisco researchers provided input into survey questions. A separate envelope was included for survey return. Respondents were entered into a raffle to receive one of three $100 gift certificates. The main outcome measure was FIT completion. Other outcomes included history of CRC screening and family history of CRC. Data were analyzed using SAS version 9.3 [8]. Descriptive statistics were computed for each outcome. We also calculated rates for individuals aged 50 and older. To assess any differences in screening among participants with family history, we used t-tests for continuous measures and chi-squared for categorical measures.
Has had test for colon cancera Yes No Not sure Has had stool test for blood Yes, within the last year Yes, more than a year ago No Not sure Has had sigmoidoscopyb Yes, within last 5 years Yes, >5 years ago Yes, but cannot remember when No Not sure Has had barium enema testc Yes, within last 5 years Yes, >5 years ago Yes, but cannot remember when No Not sure Has had colonoscopyd Yes, within last 10 years Yes, >10 years ago Yes, but cannot remember when No Not sure Has a first-degree relative with colon cancer Yes No For those with a relative, age of relativee 60
Total n = 442, n (%)
Age 40–49 n = 198, n (%)
Age 50 and older n = 244, n (%)
162 (37) 224 (51) 54 (12)
20 (10) 151 (76) 27 (14)
142 (59) 73 (30) 27 (11)
34 (8) 163 (37) 217 (49) 28 (6)
4 (2) 38 (19) 142 (72) 14 (7)
30 (12) 125 (51) 75 (31) 14 (6)
68 (15) 83 (19) 8 (2) 272 (62) 9 (2)
7 (4) 13 (7) 1 (1) 174 (88) 2 (1)
61 (25) 70 (29) 7 (3) 98 (40) 7 (3)
15 (3) 22 (5) 3 (1) 382 (87) 19 (5)
4 (2) 4 (2) 0 (0) 187 (94) 3 (2)
11 (5) 18 (7) 3 (1) 195 (80) 16 (7)
164 (37) 9 (2) 3 (1) 263 (60) 1 (1)
24 (12) 1 (1) 0 (0) 172 (87) 0 (0)
140 (57) 8 (3) 4 (2) 91 (37) 1 (1)
49 (11) 393 (89) (n = 48) 9 (19) 12 (25) 27 (56)
17 (9) 181 (91) (n = 17) 5 (29) 5 (29) 7 (41)
32 (13) 212 (87) (n = 31) 4 (13) 7 (23) 20 (65)
Two did not provide information about having a test for colon cancer. Two did not provide information about having a sigmoidoscopy. c One did not provide information about having a barium enema test. d One did not provide information about having a colonoscopy. e One did not provide information about age of relative. a
b
Downloaded from http://occmed.oxfordjournals.org/ at Anadolu University on May 21, 2014
Table 1. Responses to survey items by age groups for active duty and retired firefighters
J. M. E. Walsh ET AL.: COLORECTAL CANCER SCREENING PROGRAM IN FIREFIGHTERS 257
Results FIT kits and surveys were sent to 1203 firefighters and 498 responded (41%). Of those responding, 98% provided demographic information, 89% (442) completed the survey, 80% (400) completed the FIT and 69% (346) completed both the survey and the FIT. Of those providing a FIT, 6% (25) tested positive. The average age of respondents who provided demographic information was 53 + 10; 89% (419) were male. Of the 286 who provided ethnic information, 58% (164) were white, 7% were African-American, 11% were Latino, 18% were Asian/Pacific Islander and 6% were another ethnicity.
Survey responses are described in Table 1. Approximately half had not had prior CRC screening. Forty-five per cent had had a stool test for blood at some time, although few (8%) were up to date. About a third stated that they had had a sigmoidoscopy, although only 15% were up to date. About a third of participants had had a colonoscopy within the past 10 years. Among individuals aged 50 and older, 59% had completed a previous CRC test, 12% had had a stool test in the past year, 25% had had a sigmoidoscopy in the past 5 years and 57% within the last 10 years. As expected, rates of previous screening tests were higher in those aged 50 and older. Eleven per cent of respondents had a
Variable
No family history n = 436
Family history n = 49
P-value
Age, years, mean ± standard deviation Gender, n (%)a Male Female Ethnicity, n (%) White African-American Latino Asian/Pacific Islander Other Unknown Test for colon cancer, n (%) Yes No Not sure Stool test for blood, n (%) Yes, more than a year ago Yes, within the last year No Not sure Sigmoidoscopy, n (%) Yes, >5 years ago Yes, within last 5 years Yes, but cannot remember when No Not sure Barium enema test, n (%) Yes, >5 years ago Yes, within last 5 years Yes, but cannot remember when No Not sure Colonoscopy, n (%) Yes, >10 years ago Yes, within last 10 years Yes, but cannot remember when No/not sure
53 ± 10
55 ± 10
NS
386 (89) 49 (11)
47 (98) 1 (2)
