Cancer

Abstract

Firefighters are exposed to many cancer-causing chemicals generated in fire smoke, and others incidental to firefighting operations. The cancers most often accepted as being associated with firefighting are kidney, bladder, testicular, leukemia, non-Hodgkin lymphoma (itself actually a family of cancers), brain, colon and rectum, and prostate. The evidence for elevated risk in these and other cancers is mostly epidemiological, with some supportive animal studies. As additional evidence accumulates, the list of plausibly associated cancers has only slowly expanded (for example, melanoma). Interpretation is not straightforward because firefighters may be at lower risk overall than the general population, which is usually the reference in firefighter studies; apportionment of risk to firefighting may be underestimated. Individual cancer sites also have their own specific issues of interpretation. This chapter examines the evidence following the approach outlined in Chap. 4.

Appendix

Summary of Health Risks Associated with Occupation as a Firefighter Reported in Large Population Studies

Selected Cancer Risk Estimates from Major Studies of Firefighters. (SMRs originally given as percentages have been converted to decimals.) See text for discussion

Authors, year	Population	Design	Risk estimate		Lung	Colon	Rectum	Bladder	Kidney	Brain	CVD	COPD
Ahn, 2012 [25]	Seoul, Korea	Cohort	SIR		0.78	1.27		1.60	1.56	0.53
					0.55–1.09	1.01–1.59		1.01–2.56	1.01–2.41	0.14–1.36
Baris et al., 2001 [19]	Philadelphia FD	Cohort	SMR		1.13	1.51	0.99	1.25	1.07	0.61	1.01	0.64
					0.97–1.32	1.18–1.93	0.59–1.68	0.77–2.00	0.81–1.88	0.31–1.22	0.96–1.07	0.40–1.02
Bates, 2007 [22]	California	Cancer registry	OR		0.92	0.84		0.79	0.98	1.23	n/a	n/a
					0.84–1.01	0.74–0.94		0.68–0.92	0.81–1.20	0.97–1.56
Beaumont et al., 1991 [35]	San Francisco FD	Cohort	SMR		0.84	0.99	1.45	0.57	0.68	0.81	0.95	0.75
					0.64–1.08	0.63–1.47	0.77–2.49	0.19–1.35	0.19–1.74	0.26–1.90	0.87–1.04	0.43–1.23
Burnett et al., 1994 [14]	27 U.S. States	Surveillance	PMR		1.02	n/a	1.48	0.99	1.44	1.03	1.01	0.83
					0.94–1.11		1.05–2.05	0.70–1.37	1.08–1.89	0.73–1.41	0.97–1.05	0.73–0.94
Daniels, et al. [NIOSH], 2013 [27]	3 US Cities Chicago, Philadelphia, San Francisco pooled	Cohort	SMR		1.10	1.31	1.45	0.99	1.29	1.01		0.73
					1.04–1.17	1.16–1.48	1.16–1.78	0.79–1.27	1.05–1.58	0.79–1.27		0.65–0.81
			SIR		1.12	1.21	1.11	1.12	1.27	1.02
					1.04–1.21	1.09–1.33	0.95–1.30	1.00–1.25	1.09–1.48	0.76–1.34
Demers, Heyer, Rosenstock, 1992 [82]	Pacific Northwest Municipal FDs	Cohort	IDR v. Police:		0.95	158	0.89	0.16	n/a	163	0.88	0.89
					0.67–1.33	0.73–3.43	0.30–2.66	0.02–1.24		0.70–3.79	0.74–1.04	0.47–1.69
Deschamp et al., 1995 [15]	Paris France	Cohort	SMR		1.12						0.74	1.83
					0.45–2.30						0.20–1.90	0.05–10.21
Dubrow and Wegman, 1984 [125]	Massachusetts firefighters, 1971–73	Surveillance	SMOR on mortality		0.86	0.76	0.60	1.10	1.22	0.86	n/a	n/a
Eliopulos et al., 1984 [122]	Western Australia. Wild fire fighters	Cohort	SMR		1.04	1.59	n/a	1.08	n/a	0.84	0.65
					0.42–2.13	0.43–4.07		0.29–2.76		0.60–1.14	0.13–1.90
Feuer and Roseman, 1986 [106]	New Jersey	Cohort	PMR, NJ state comparison		0.92	n/a	n/a	n/a	n/a	n/a	1.11	n/a
Giles et al., 1993 [13]	Melbourne FD, Australia	Cohort	SIR		0.77	1.36	1.02	n/a	n/a	n/a
					0.28–1.68	0.62–2.59	0.28–1.68
Glass et al., [47]	Australian FF Health Study	Cohort	SIR, SMR: here SIR for cancer SMR for non-malignant disease		0.81	1,13	1.18	0.85	0.97	0.76	0.64	0.61
					0.65–1.00	0.91–1.38	0.89–1.54	0.54–1.27	0.67–1.36	0.44–1.24	0.55–0.73	0.39–0.93
Guidotti, 1992 [44]	Municipal firefighters, Alberta	Cohort	SMR		1.42	1.61	3.16	4.14	1.47	1.10	1.57
					0.91–2.11	0.88–2.71	0.86–8.08	1.66–8.53	0.30–4.29	0.92–1.31	0.79–2.81
Guralnick, 1963 [126]	U.S. census, 1950	Surveillance	SMR to 65y		0.83	0.93	n/a	n/a	n/a	0.72	n/a
Hansen, 1990 [115]	Danish census	Cohort from census sample	SMR, v. civil servants		1.63						1.15	n/a
					0.75–3.10	n/a	n/a	n/a	n/a	n/a	0.74–1.71
Heyer et al., 1990 [83]	Seattle FD	Cohort	SMR		0.97	0.79	0.65	n/a	n/a	0.95	0.75	n/a
					0.65–1.39	0.32–1.64	0.08–2.37			0.20–2.79	0.63–0.89
Kang et al., 2008 [23]	Massachusetts, cancer registry, follow-up to Sama, 1990	Surveillance	SMOR	All other	0.91	1.15	1.03	1.19	1.01	1.38
					0.76–1.10	0.93–1.43	0.77–1.38	0.93–1.52	0.74–1.38	0.87–2.12
				v. MA police	1.02	1.36	0.86	1.22	1.34	1.90
					0.79–1.31	1.04–1.79	0.58–1.26	0.89–1.69	0.90–2.01	1.10–3.26
Kizer et al., 1987 [127]	California, adjusted for smoking, alcohol, SES	Surveillance	SMR Adjusted		1.32	1.31	n/a	1.15	n/a	1.26	0.57	n/a
					0.89–1.90	0.48–2.84		0.24–3.37		0.99–1.58	0.07–2.06
Lindsay et al., 1993 [128]	Canadian labour force sample	Cohort from census sample	SMR v. employed		1.11	1.54	n/a	n/a	n/a	0	n/a	n/a
					0.41–2.42	0.19–5.56				0.00–6.25
Ma et al., 1998 [16] white	24 US states	Surveillance	MOR		1.1	1.0	1.1	1.2	1.3	1.0	n/a	n/a
					1.0–1.2	0.9–0.2	0.8–1.6	0.9–1.6	1.0–1.7	0.8–1.4
Ma et al., 1998 [16] African–American	24 US states	Surveillance	MOR		0.8	2.1	0	1.2	1.3	1.0	n/a	n/a
					0.5–1.3	1.1–4.0		0.9–1.6	1.0–1.7	0.8–1.4
Ma et al., 2005 [43]	Florida certification registry	Cohort	SIR		0.65	1.16	0.88	1.29	0.78	0.58	n/a	n/a
					0.54–0.78	0.92–1.45	0.56–1.32	1.01–1.62	0.52–1.14	0.31–0.97
Mastromatteo, 1959 [5]	Toronto FD	Cohort	SMR		n/a	n/a	n/a	n/a	n/a	n/a		n/a
Massachusetts Dept. of Public Health, 1990	Massachusetts resident firefighters	Surveillance incidence	SMOR State:		1.22	1.20	1.45	1.59	n/a	0.86	n/a	n/a
					0.87–169	0.80–182	0.84–219	1.02–2.50		0.34–2.15
Milham, 1983	Washington state residents	Surveillance	PMR		1.05	0.90	1.03	2.33	1.15	1.94	1.16	0.53
Musk et al., 1978 [129]	Boston FD	Cohort	SMR		0.88	n/a	n/a	0.92	1.03	0.86	n/a	n/a
Petersen and Milham, 1977 [133]	California state residents	Surveillance	PMR		1.68	1.13	0.48	0.82	1.75	0.90	1.08	[70]
Pukkala et al., 2014 [28]	Nordic countries, identified in 1970	Cohort	SIR		0.97	1.14	0.99	1,11	0.94	0.86
					0.87–1.09	0.99–1.31	0.82–1.19	0.96–1.28	0.75–1.17	0.66–1.10
Rosenstock et al., 1990 [130]	Pacific Northwest	Cohort	SMR v. US:		1.34	0.95	1.19	0.23	0.27	2.10	0.82	1.19
					0.90–1.91	0.41–1.87	0.44–2.59	0.03–0.83	0.03–0.87	1.31–3.17	0.74–0.90	0.72–1.83
Sama et al., 1990 [24, 131]	Massachusetts, cancer registry	Surveillance	SMOR v police		1.30	1.04	0.97	2.11	n/a	1.52	n/a	n/a
					0.84–2.03	0.59–1.82	0.50–1.88	1.07–4.14		0.39–5.92
Tornling et al., 1990 [132]	Stockholm FD	Cohort	SMR		0.90	0.85	2.07	0.31	1.10	2.79	0.98	0.00
					0.53–1.42	0.31–1.85	0.89–4.08	0.01–1.70	0.30–2.81	0.91–6.51	0.81–1.17	0.00–0.48
Vena and Fiedler, 1987 [116]	Buffalo FC	Cohort	SMR		0.94	1.83	2.08	2.86	1.30	236	0.92	n/a
					0.62–1.36	1.05–2.97	0.83–4.28	130–5.40	0.26–3.80	0.86–5.13	0.81–1.04