There has been much debate and conflicting evidence regarding whether firefighters have a higher risk of developing cancer than the general public. The reasons for this is are many: cause and effect is difficult to prove in medical studies, cancer is a collection of various different diseases and subtypes, and performing a study researching cancer for a single group across the country is technically difficult.
Although it is difficult to prove that firefighting causes cancer, it is intuitive that the exposures faced by firefighters increase the risk of developing cancer. Today, most fires that are not wildland fires involve some type of burning plastic or other synthetic materials. These materials produce toxic gases that when burned contain carcinogenic compounds. Carcinogenic compounds are chemicals that when exposed to the body can cause permanent damage to cells that can induce a transformation into a cancerous cell. Not only are firefighters exposed to the inhalation of these gases, they are exposed to them back at the station from the carcinogenic compounds that collects on turnout gear and equipment during a fire. Firefighters are also exposed to toxic chemicals during hazardous materials incidents. Additionally, firefighters are exposed to diesel soot at the station that is known to cause cancer.
Studies published in the past few years suggest that firefighters do have an increased risk of certain cancers. A study released by the University of Cincinnati suggests that firefighters have a higher risk of the following cancers: testicular, brain, colon, melanoma, non-Hodgkin's lymphoma, stomach and rectal cancer. This study demonstrates results similar to another study demonstrating that firefighters in Massachusetts had higher rates of colon and brain cancers than the general public. These studies suggest that not only is firefighting inherently dangerous, it is associated with occupational exposures that increase the risk of cancer.
Since firefighters may be at an increased risk of cancer due to occupational exposure, this column offers suggestions for decreasing the risk. There are two main strategies for preventing cancer fatalities: prevention of developing cancer by minimizing exposure to carcinogenic substances and early diagnosis when the disease is highly curable. Below are suggestions to help minimize your exposure to the carcinogenic compounds encountered on the job and current screening recommendations for common cancers.
Diesel exhaust exposure is addressed by the National Fire Protection Agency (NFPA) in its 1500 standard. The standard states, "The fire department shall prevent exposure to firefighters and contamination of living and sleeping areas to exhaust." Many different products are available to remove diesel exhaust and minimize exposure to firefighters, including in-station exhaust systems, ventilation systems and apparatus-mounted removal systems. The above information can be used to justify the cost of these systems to help decrease the risk of cancer and improve the overall health of firefighters.
Colonoscopy is used to screen for colon cancer and polyps. The American College of Gastroenterology (ACG) recommends colonoscopies every 10 years beginning at the age of 50. However, for patients with a family history of colon cancer, the ACG recommends colonoscopies starting at age 45. Your healthcare provider may recommend other tests, including annual fecal occult blood tests that look for signs of blood in your stool. A sigmoidoscopy is similar to a colonoscopy, but only the distal end of the colon is visualized. Some authorities recommend a sigmoidoscopy every five years and a full colonoscopy every 10 years.
There has been much debate recently whether cancer screening reduces the number of cancer fatalities. This is a debate that will occur in the medical circles for years and it remains to be seen if this current discussion will lead to any changes in cancer-screening guidelines. However, given that firefighters may be at a higher risk of developing cancer, all firefighters should speak to their healthcare providers and be screened for cancer according to current guidelines. While some of the screening procedures sound unpleasant, early detection is key to increasing the chance of surviving cancer and keeping us around longer to enjoy being around the station and our families.
DR. RAYMOND BASRI, MD, FACP, is in the private practices of internal medicine and diagnostic cardiology in Middletown, NY. Dr. Basri is a Diplomate of the American Board of Internal Medicine and president of the Mid-Hudson Section. He received the 2008 Laureate Award of the American College of Physicians, of which he is a Fellow. Dr. Basri also is clinical assistant professor of medicine at New York Medical College, attending physician in the Department of Internal Medicine at Orange Regional Medical Center and on the consulting staff in cardiology at The Valley Hospital in Ridgewood, NJ. He is a member of the Excelsior Hook and Ladder Company in Middletown and a deputy fire coordinator for Orange County. Dr. Basri is the senior physician of the Disaster Medical Assistance Team (DMAT NY-4). He is a senior aviation medical examiner for the Federal Aviation Administration (FAA) and chief physician for Health & Safety Specialists in Medicine, which does onsite medical examinations for the fire service and consultant to FirePhysicals.com. ERIC BERGMAN, PA-C, is a physician assistant practicing internal medicine at Hartford Hospital in Hartford, CT. He earned a bachelor of science degree in allied health from the University of Connecticut and a master's degree from Albany Medical College. He is a member of the Killingworth, CT, Volunteer Fire Company; a past company officer and life member of the Avon, CT, Volunteer Fire Department; and a past member of the Shaker Road-Loudonville Fire Department in Colonie, NY.
Researchers at the National Institute for Occupational Safety and Health (NIOSH) are undertaking a multi-year study to examine the relationship between firefighting exposures and risk of cancer.
The records-based study will include approximately 18,000 current and retired career firefighters from suburban and large city fire departments. The study will provide critical information for the International Agency for Research on Cancer (IARC) as it continues to review the carcinogenicity of firefighting.
When complete, the study results and recommendations will be communicated to firefighters with help from the International Association of Fire Fighters (IAFF), International Association of Fire Chiefs (IAFC), Firefighter Cancer Support Network, labor and management from each participating fire department, and other firefighter organizations