Colorectal cancer stage at diagnosis in male Florida firefighters.

BACKGROUND

Firefighters display increased risk of colorectal cancer (CRC). The distribution for CRC stage at diagnosis among firefighters compared to other occupational groups is unknown.

METHODS

Colorectal cancer cases from the Florida Cancer Data System cancer registry (2001-2014) for males ≥20 years were ascertained. Firefighters were identified through either direct linkage with Florida Fire Marshal's Office employment and certification records or Standard Occupation Codes annotated at diagnosis. White-collar, blue-collar, and service workers were also identified according to these codes. Stage at diagnosis was classified as localized, regional, or distant. Bivariate tabulations of occupational groups and clinicodemographic covariates were conducted using contingency tables. The association between occupational group and stage at diagnosis was assessed by multivariable multinomial logistic regression adjusting for year of diagnosis, age, race and ethnicity, tobacco use and cancer diagnosis sequence. Adjusted odds ratios (aORs) are reported.

RESULTS

In total, 13 813 CRC cases, including 346 cases among firefighters, were analyzed. Firefighters were more likely to be non-Hispanic white and be diagnosed with a single primary cancer. One hundred and forty (40.5%) firefighter CRC cases were localized. Using firefighters as the referent group, only blue-collar workers approached 50% increased odds of later-stage diagnoses (aORRegional = 1.44; 95% CI = 1.12 to 1.84; P = .004; aORDistant =1.49; 95% CI = 1.11 to 2.01; P = .008). Individuals ≥50 years and the first among multiple primary cancers were more likely to have localized CRC (P < .001).

CONCLUSION

Although firefighters have increased CRC risk, they tend to be diagnosed more localized. Improved screening across worker groups can increase the percentage of localized CRCs.