The facts are indisputable.
For most of the last decade, USFA has named cardiac health as the primary risk facing firefighters. The kitchen table and a firehouse culture built around food seemed to be the most perilous manageable health issue that we encountered.
As it turns out, a more ominous threat has been under our nose the entire time. We now know, and are learning more every day, that it is in fact cancer that is the most pervasive hazard to a firefighter.
While new research has been completed, and much more’s now underway, the studies on firefighter occupational-cancer exposure and risks have sparked not only dialogue in fire stations across the country but quite possibly the most significant—not to mention fastest—culture shift in our industry.
Here is some of what we know: Cancer caused 61% of the career firefighter line-of-duty deaths from January 1, 2002, to March 31, 2017, according to data from the International Association of Fire Fighters (IAFF).
Heart disease caused 18% of career LODDs for the same period. Cancer created 70% of the line-of-duty deaths for career firefighters in 2016. Firefighters have a 9% overall higher risk of being diagnosed with cancer and a 14% higher risk of dying from cancer than the general U.S. population, according to research by the CDC/National Institute for Occupational Health and Safety (NIOSH).
From the studies done to date, we also know that firefighters’ risks are significantly higher for some specific types of cancer than the general population. The cancers responsible for this higher risk profile are respiratory, gastrointestinal and kidney.
Not only are we all exposed and at an elevated risk of cancers commonly found in the average American population, but because of our work environment our likelihood of contracting rare cancers, such as mesothelioma, is best described by a single word: staggering.
While we’re still learning about the exposure risks and their effects over time, we do know a firefighter’s chances of contracting:
- Testicular cancer: 2.02 times the risk (again: 100% = double = 2 times)
- Mesothelioma: 2.0 times greater risk
- Multiple myeloma: 1.53 times greater risk
- Non-Hodgkin’s lymphoma: 1.51 times greater risk
- Skin cancer: 1.39 times greater risk
- Malignant melanoma: 1.31 times greater risk
- Brain cancer: 1.31 times greater risk
- Prostate cancer: 1.28 times greater risk
- Colon cancer: 1.21 times great risk
- Leukemia: 1.14 times greater risk
What else do we need on the firefighter cancer-research agenda?
Moving forward, we need to expand the current scope of the firefighter cancer-research agenda to truly understand the full breadth of the problem and how we all can be protected. The areas of decontamination, detoxification, and screening/monitoring will be of particular importance.
Volunteer, Women and Nonwhite Firefighters
There is presently little data about cancer among volunteer firefighters, but often because of funding challenges that impact PPE quality/availability, they’re also some of the most at risk. The Firemen's Association of the State of New York (FASNY) and Northwell Health launched a research project in 2017 to examine cancer incidence and mortality among New York volunteers that will be one of the first of its kind in the country. As leaders in the fire service, we must issue a call for work like this to be expanded from coast to coast.
We also know that there are few studies about cancer among women and nonwhite firefighters. Researchers are starting to turn their attention to the specific cancer risks faced by women. A study examining the San Francisco Fire Department showed that of the approximately 16% of its firefighters that are women 15% between the ages of 40 and 50 have been diagnosed with breast cancer—six times the national average. Over the last decade, more than 250 of the department's active and retired firefighters—both men and women—have died from various forms of cancer.
Because black men have the highest risk of prostate cancer overall, the International Association of Black Professional Firefighters provides periodic prostate-cancer prevention tips to its members via an email newsletter. This initiative and many others offer a great start, but more needs to be done. The clock is ticking.
Start reducing your risk now.
We know some things that help to reduce exposure:
- Keep your mask on.
- Remove contaminated gear as soon as possible.
- Clean on the scene: face, arms and groin.
- Use a decontamination solution to eliminate carcinogens from turnout gear.
- Reclean: shower, scrub and change into a clean uniform.
- Launder turnout gear and your fire hood as soon as possible following contamination.
- Live a healthy lifestyle: nutritious food, exercise, sleep, preventative medicine.
- Get regular screenings: annual firefighter medical/physical.
This list and the importance of following through with each of the recommendations are reinforced in recent research out of the United Kingdom.
In the first study of its kind, experts at the University of Central Lancashire recently discovered firefighters were more likely to absorb cancerous gases through their skin than by inhaling them. The researchers found dangerously high levels of harmful chemicals remain on PPE following exposure to smoke.
This same study found that the cancer death rate among firefighters aged 75 or under was up to three times higher than in the general population in the United Kingdom. The risk of developing cancer among U.K. firefighters because of skin absorption of toxic chemicals is as much as 350 times above the level that would prompt government intervention in the United States.
Exposure to toxic gases and the effect on the long-term health of firefighters is not monitored in the U.K., despite cancer deaths in firefighters growing steadily since the 1970s.
For the study, researchers collected samples from firefighters' skin and protective equipment at two U.K. fire stations and examined them for cancerous gases created during a blaze, known as polycyclic aromatic hydrocarbons (PAHs). Researchers found that the methods used to clean firefighters' protective clothing and equipment weren’t effectively carried out, meaning the length of time that skin was exposed to fire toxins increased.
Designing PPE to Protect, Resist and Repel
PPE manufacturers have started to respond to the risk and are partnering with higher-education and researchers to develop the next best thing. Hitting the market in November of 2017 was new, certified turnout gear with improved smoke and soot resistance that went through two years of development at North Carolina State’s College of Textiles. The new turnouts help stop particulates from reaching firefighters’ skin at three junctions in the suit: the wrists, waist and ankles.
N.C. State researchers have a second project in the works to protect the skin around firefighters’ faces and necks, using an improved flash hood that keeps out smoke, soot and chemicals. While this type of hood is still new gear, it could limit exposure to cancer-causing agents.
Putting Protections in Place Now for Future Generations
Many in our industry have worked quickly to safeguard and cut the exposure to their employees, but there’s more to do. Recently, the U.S. Senate Committee on Health, Education, Labor and Pensions voted unanimously to pass the Firefighter Cancer Registry Act of 2017, bringing this critical protection one step closer to becoming law. Introduced by Senators Robert Menendez and Lisa Murkowski, the bill establishes the first national cancer registry for firefighters.
Housed within the Centers for Disease Control and Prevention, the cancer registry will collect detailed data on the occurrences of cancer by firefighters to assist scientists with the specialized information they need for research activities. This research will help strengthen our understanding of the link between firefighting and cancer and could lead to better prevention and safety protocols.
Getting this bill and laws at the local level passed will require the work and collaboration of every single facet of the fire service to be successful. Passage of this legislation and others like it will hold the balance of our firefighter’s health, wellness and wellbeing within their pages.
A Call to Action
There are countless reasons to provide annual medical physicals to firefighters, and now we’ve added one more. Establishing a health baseline that’s carefully tracked and monitored throughout the course of someone’s career offers the opportunity to catch illness early and to have thorough documentation to ensure that firefighters who do contract cancer have the support of benefits and services they deserve.
Join the IAFC SHS Section and the National Volunteer Fire Council by participating in the 2018 Safety Stand Down. Take the time with your crews to understand the risk, review the resources and recognize the pivotal role that annual medical physicals play as the starting point for all firefighter health and safety initiatives.