Author: 
Keith Vensey, MBA, MPH, Director of Geographic Health Equity Alliance

March — National Colorectal Cancer Awareness Month

Through our Geographic Health Equity Alliance (GHEA), CADCA observes National Colorectal Cancer Awareness Month — a health observance dedicated by President Clinton in 2000 — to raise awareness about the disease among our partners, coalitions, and the communities they serve.  GHEA promotes colorectal cancer preventive measures such as informing our members of age-centric screening recommendations.  Adults should be screened via colonoscopy starting at age 50 years – 40 years for African Americans – and continue screenings until age 75 at a frequency deemed appropriate by their doctor. A form of cancer originating as polyps in the large intestine turned cancerous, colorectal cancer is also known as colon cancer and rectum cancer. 

Colorectal Cancer Risk Factors

As with other forms of cancer, many lifestyle factors have been associated with developing colorectal cancer.  Some of the strongest determinants of colorectal cancer include diet, weight, exercise, and smoking.

Diet: According to the American Cancer Society, a diet comprising high amount of red meat (e.g. beef, pork, or lamb) and processed meat (e.g. hot dogs and some luncheon meats) raises your risk of developing colorectal cancer.  Cooking meats at very high temperatures (e.g. frying, broiling, or grilling) creates chemicals that might increase your chances of developing colorectal cancer as well.  The extent to which cooking meats increases your cancer risk is unclear – ask your doctor for more details. 

Overweight or Obese:  The risk of developing and dying from colorectal cancer significantly increases if you are overweight or obese.  Physicians, public health professionals, and dietitians among others, use body mass index (BMI) to calculate a weight considered healthy given one’s height.  The oft quoted metric provides an estimate for the average person; it is not the be-all-end-all. Consult your physician, nurse or another trained and trusted healthcare provider for a clearer picture of your optimal weight.

Physical Inactivity:  Leading a sedentary life may increase your chances of developing colorectal cancer.  Regular physical activity improves your overall health and fitness – regardless of your age.  The Centers for Disease Control and Prevention (CDC) defines physical activity as anything that gets your body moving.  For adults aged 18 to 64, increasing or maintaining an acceptable level of exercise can be achieved by engaging in two types of physical activity every week: (1) two hours and thirty minutes of moderate-intensity aerobic activity such as briskly walking around your neighborhood or a shopping mall.  This equates to about 21 minutes a day, seven days a week; (2) Working all major muscle groups (legs, hips, back, arms, chest) two or more days a week, activities best defined by your doctor or nurse. 

Research shows dog owners on average walk 22 minutes more daily than people who do not have a pooch.  According to Animal Planet, having an active dog not only increases one’s level of physical activity, but man’s best friend also livens his or her owner’s social life.  National Public Radio (NPR) featured a story discussing the benefits of dog ownership, particularly the increased likelihood of achieving adequate levels of physical activity.

Smoking:  About half of Americans who continue to smoke will die because of this deadly habit.  Annually, over 480,000 people in the United States succumb to illnesses related to smoking traditional (combustible) cigarettes.  Not only does smoking traditional cigarettes cause lung cancer —smoking being a prime factor in 80 percent of all lung cancer deaths — it also increases the risk of developing colorectal cancer. 

Consider one of CADCA’s partners’ experience with colorectal cancer. Mark, a CDC Tips from Former Smokers® campaign participant who smoked and got colorectal cancer, collaborated with CADCA and West Virginia-based Community Connections to share his story in a culturally competent and localized manner on a barn.  Watch a video highlighting our partnership efforts here.

To learn more about additional risk factors for developing colorectal cancer, click here.

Signs and Symptoms of Colorectal Cancer

The onset of colorectal cancer may not cause symptoms right away. However, if you experience one of the following symptoms please contact your healthcare provider immediately.

  • Change in bowel habits — diarrhea, constipation, narrowing of the stool — that lasts more than a few days
  • A persistent feeling of needing to have a bowel movement that does not go away after doing so
  • Bright red blood visible in toilet after having a bowel movement
  • Darker than usual colored stool, which is also an indicator of bleeding inside your colon or rectum
  • Experiencing belly pain such as cramping
  • Weakness and fatigue
  • Unintended weight loss

Colorectal cancerous cells often cause bleeding into the digestive tract — particularly the large intestine.  This bleeding may show-up as darker than normal stool.  Also, bleeding in the digestive tract may not change the color of your stool — the shades of which may continue to look normal.  Unchecked bleeding can lead to anemia, which may be the first sign of colorectal cancer for some people.  Many of the symptoms listed here may also be caused by other conditions such as infections, hemorrhoids, or irritable bowel syndrome (IBS) and not necessarily colorectal cancer.  There is no way to know for sure until a trained healthcare provider examines you.

As coalition leaders and members, you can support National Colorectal Cancer Awareness Month in accordance to CADCA’s Seven Strategies to Affect Community Change.  Consider some of GHEA’s ideas below.

  1. Providing Information – GHEA can provide educational materials, statistics, and subject matter experts’ interpretations of recent studies regarding colorectal cancer to support any presentations, workshops or seminars you wish to offer your community members.
     
  2. Enhancing Skills – If you prefer to hear directly from a colorectal cancer subject matter expert, say via webinar, GHEA may be able to help.  We can work with experts to develop content specific to your informational needs.  We often provide information via our Network Navigator (e-newsletter), through CADCA’s Coalitions Online, or as breakout sessions or trainings during CADCA’s National Leadership Forum and Mid-Year Training Institute.  Contact Leah Farchmin at lfarchmin@cadca.org for more information.
     
  3. Providing Support – As they go through their day-to-day activities, some community members may not give their risk for colorectal cancer a second thought.  Coalitions can create activities purposed with informing the community of ways to minimize risks – such as moderating their intake of certain foods or remembering to incorporate a brisk walk into their daily routine.  There are opportunities to highlight those in the community current doing those things to serve as motivation for others.  Coalitions and their community partners may be able to implement programs such walking groups, bringing neighbors together for a fun activity as well as increase physical activity among those most susceptible to developing colorectal cancer.
     
  4. Enhancing Access/Reducing Barriers – Collaborative efforts can eliminate barriers to receiving colorectal cancer screenings.  Consider a group of partners GHEA learned about in Nebraska. In one county, local health department personnel worked with local pharmacists to distribute colorectal cancer screening kits to patients.  The patients used the kits to mail in a sample of their stool to already-identified labs for analysis.  The mailing fees were pre-paid.  The results of the screenings were sent to patients’ physicians for interpretation and follow-up – recommending additional screenings and treatment if warranted.  The Nebraskans created this partnership to remove transportation and appointment scheduling barriers among others.  Given people tend to go to the bathroom everyday, collecting a specimen did not require a herculean effort too disruptive to their daily routine.  If your coalition comprises members of the healthcare sector or those with access to the healthcare sector, this may be an activity worth considering.  Contact us to learn more information.
     
  5. Changing Consequences (Incentives/Disincentives) – To expound on the idea stated in #4, arranging for transportation regarding any necessary additional follow-up services is something coalition members can achieve.  Local community sectors may be willing to serve as chauffeurs, donate gas money or a fare for a rideshare (e.g. Lyft, Uber), even pitch in to hire professional transportation services to ensure their neighbors can see a doctor to receive vital services.  Needing to remove transportation barriers, for example, is quite frequent in rural areas and may be a motivating factor for some people to seek treatment.
     
  6. Physical Design – According to the Environmental Protection Agency (EPA), built environments are man-made or modified structures providing people with living, working and recreational spaces.  Places and spaces such as community basketball courts and well-lit, paved trails or running tracks offer areas for safe walking, running, cycling and other physical activities. Coalitions have play a significant role in protecting, reclaiming, and developing built environments for the betterment of the communities they serve.  For instance, many coalitions have cleaned and modernized long-forgotten parks — increasing their walkability and appeal to community members in the process. To increase physical activity in your community, what are some built environments your coalition has the capacity to aesthetically and functionally improve?  Broken sidewalks?  Nonexistent sidewalks?  A decommissioned military gymnasium?   
     
  7. Modifying/Changing Policies – As history has shown us, comprehensive smoke-free laws have been very effective in protecting non-smokers from exposure to secondhand smoke and thus reducing their risks for developing a whole host of tobacco related illnesses (e.g. colorectal cancer).  Such policies are known to prompt smokers ready to quit to do so, often successfully kicking the habit permanently.  Increasing the tax on cigarettes and other tobacco products is an effective strategy to drive down use as well.  Quitting smoking can decrease the risk of developing colorectal cancer. 
     

As a guiding force mobilizing communities to enact and enforce comprehensive smoke-free laws which protect non-smokers from exposure to secondhand smoke, effective pricing strategies to drive down tobacco use, and increasing the minimum legal sale age for purchasing tobacco products to 21, coalitions have the power to achieve great results.  While very successful to-date, coalitions’ work remains.  Some examples include reducing and ultimately eliminating risk factors associated with smoking and use of other tobacco products that can lead to issues in short-term (e.g. brain development issues in teens) as well as later in life (e.g. colorectal cancer).  Think e-cigarettes.  JUULing.  Legalization of marijuana.  Nicotine and THC (active agent in marijuana) e-juices.

Coalitions can ensure existing comprehensive smoke-free laws cover traditional cigarettes and e-cigarettes in all its forms — vape pens, e-hookah, and JUULes included.Coalition leaders and members can inform local decision makers, teachers, parents, and other adults interfacing with adolescents on the meaning of JUULIng and how to tamp down its use.Lastly, as with other major collaborative efforts, coalitions can advocate for their states to increase the minimum legal age to purchase tobacco products to 21.

According to the 2014 Surgeon General’s Report, nearly nine out of 10 adults smokers started before age 18. Preventing legal access to tobacco products for as long as possible greatly reduces the chances teenagers and young adults will ever start using them. To date, five states have enacted Tobacco 21 laws — Hawaii, California, New Jersey, Maine, and Oregon. You can prepare your state to do so as well.

CADCA’s Seven Strategies to Affect Community Change can shape many activities to ensure people have valuable information needed to make informed health-related decisions.  Established coalitions with connections to community sectors can efficiently disseminate information as well as convene groups to plan and execute activities.  With information dissemination regarding colorectal cancer, coalitions already understand how to appropriately frame discussions in accordance to their community’s history with processing and addressing various public health and medical issues – which goes a long way to increase messages’ resonance and prompt behavior change.