Cancer risk among career male and female Florida firefighters: Evidence from the Florida Firefighter Cancer Registry (1981‐2014)

Lee, David J.; Koru‐Sengul, Tulay; Hernandez, Moises; Caban‐Martinez, Alberto J.; McClure, Laura A.; MacKinnon, Jill; Kobetz, Erin

doi:10.1002/ajim.23086

Cited by 53 publications

(62 citation statements)

References 60 publications

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“…In 2018, our research team has conducted a linkage between records from FCDS and the Florida FMO that resulted in a dataset of 3928 male and female Florida career firefighters with cancer. Using this linked dataset we identified an increased risk of melanoma, prostate, testicular, thyroid, and late‐stage colon cancer among male firefighters, and brain and thyroid cancer among female firefighters 9 . These findings are fairly consistent with the most recently published meta‐analysis, although the magnitude of the estimates varied by cancer site 7 .…”

Section: Introductionsupporting

confidence: 84%

“…The details of the FCDS–FMO data linkage have been reported previously 9 . Briefly, FCDS performed a probabilistic linkage between 1981 and 2014 FCDS data (~3.3 million records) and 1972–2012 Florida State FMO employment and certification data ( n = 109,009).…”

Section: Methodsmentioning

confidence: 99%

“…Firefighters, for example, face many carcinogenic exposures, both confirmed and suspected 1‐5 . Indeed, numerous studies and meta‐analyses have demonstrated increased incidence and mortality for select cancers among firefighters 1,6‐9 . It remains difficult, though, to accurately assess the level of exposure that firefighters encounter and what contribution these exposures make to cancer risk, given the long latency of most cancers and the changes in exposure both over time and over the course of a firefighter's career.…”

Section: Introductionmentioning

confidence: 99%

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Comparing cancer risk estimates using occupational record linkage approaches in male Florida firefighters

McClure

Koru‐Sengul

Hernandez

et al. 2020

American J Industrial Med

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BackgroundFirefighters have an increased risk of cancer, but variations in reported results could be due to differences in occupational case ascertainment. This study compares cancer risk estimates generated by identifying firefighters from their occupational title available in the Florida Cancer Data System (FCDS) versus identification by a linkage method between the FCDS and the Florida State Fire Marshal's Office.MethodsFlorida firefighter employment records (1972–2012; n = 109,009) were linked with FCDS data (1981–2014; ~3.3 million records), identifying 3760 primary cancers in male firefighters. Using the FCDS occupational data field we identified 1831 male cancer cases in those classified as firefighters, first‐line supervisors of firefighting and prevention workers, fire inspectors, emergency medical technicians, or paramedics. Age and calendar year‐adjusted odds ratios (aOR) and 95% confidence intervals for firefighters versus non‐firefighters were calculated for both groups.ResultsFor skin cancers the risk estimate for FCDS‐indentified firefighters was substantially lower than in the employment‐record‐linked firefighters (aOR = 1.06; 0.87–1.29 vs. 1.54; 1.37–1.73), but for endocrine system cancers it was greater (aOR = 2.36; 1.77–3.14 vs. 2.08; 1.71–2.53). Remaining cancer risk estimates were in the same direction for the two samples except for lymphoma (aOR = 1.10; 0.90–1.34 vs. 0.86; 0.75–0.99).ConclusionReliance on occupational title in cancer registry records to characterize firefighter cancer risk may result in estimates that are over‐ or underestimated depending on cancer site. The authors recommend moving toward national linkages between cancer registries and certification or other administrative records, which are a vital resource for firefighter cancer research.

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Section: Introductionsupporting

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparing cancer risk estimates using occupational record linkage approaches in male Florida firefighters

McClure

Koru‐Sengul

Hernandez

et al. 2020

American J Industrial Med

Self Cite

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“…Structural fires fueled by common household furnishings can produce hundreds of compounds including those that may expose firefighters to vapor, gas, and particulate contamination (Austin et al 2001a(Austin et al , 2001bJankovic et al 1991). Epidemiological studies suggest that firefighters have increased risk for numerous types of cancer including testicular, prostate, and non-Hodgkin's lymphoma (Daniels et al 2014(Daniels et al , 2015Glass et al 2014; International Agency for Research on Cancer [IARC] 2010; Jalilian et al 2019;Lee et al 2020;LeMasters et al 2006;Pukkala et al 2009;Tsai et al 2015). As the fire service has become more aware of the fireground risks, personal protective equipment (PPE) manufacturers have developed new designs for turnout jacket and pants, hoods, gloves, and other aspects of the firefighting PPE ensemble.…”

Section: Introductionmentioning

confidence: 99%

Impact of select PPE design elements and repeated laundering in firefighter protection from smoke exposure

Mayer

Horn

Fent

et al. 2020

Journal of Occupational and Environmental Hygiene

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As the Fire Service becomes more aware of the potential health effects from occupational exposure to hazardous contaminants, personal protective equipment (PPE) manufacturers, and fire departments have responded by developing and implementing improved means of firefighter protection, including more frequent laundering of PPE after exposures. While laboratory testing of new PPE designs and the effect of laundering on PPE fabric provides a useful way to evaluate these approaches, laboratory scale testing does not necessarily translate to full garment protection. Utilizing a fireground smoke exposure simulator, along with air and/or filter-substrate sampling for polycyclic aromatic hydrocarbons (PAHs) and benzene, this pilot study tested the chemical-protective capabilities of firefighting PPE of different designs (knit hood vs. particulate-blocking hood, turnout jacket with zipper closure vs. hook & dee closure), including the impact of repeatedly exposing and cleaning (through laundering or decontamination on-scene) PPE 40 times. Overall, PAH contamination on filters under hoods in the neck region were higher (median PAHs ¼ 14.7 mg) than samples taken under jackets in the chest region (median PAHs ¼ 7.05 mg). PAH levels measured under particulate-blocking hoods were lower than levels found under knit hoods. Similarly, zippered closures were found to provide a greater reduction in PAHs compared to hook & dee closures. However, neither design element completely eliminated contaminant ingress. Measurements for benzene under turnout jackets were similar to ambient chamber air concentrations, indicating little to no attenuation from the PPE. The effect of laundering or onscene decontamination on contaminant breakthrough appeared to depend on the type of contaminant. Benzene breakthrough was negatively associated with laundering, while PAH breakthrough was positively associated. More research is needed to identify PPE features that reduce breakthrough, how targeted changes impact exposures, and how fireground exposures relate to biological absorption of contaminants.

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“…The copyright holder for this preprint this version posted October 7, 2020. ; https://doi.org/10.1101/2020.10.06.20207498 doi: medRxiv preprint compared to the general Florida population (Ma et al 2006) and a more recent study of Florida firefighters using that state's cancer registry found that women firefighters had elevated risk of melanoma, thyroid, and brain cancer (Lee et al 2020).…”

Section: Introductionmentioning

confidence: 99%

Organophosphate and organohalogen flame-retardant exposure and thyroid hormone disruption in a cohort of female firefighters and office workers from San Francisco

Trowbridge

Gerona

McMaster

et al. 2020

Preprint

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Background: Occupational exposures to flame retardants (FR), which are suspected endocrine disrupting compounds, may be of particular concern for firefighters as they are commonly found in consumer products and have been detected in fire station dust and firefighter gear. Objectives: The Women Workers Biomonitoring Collaborative is a community based participatory research study that sought to measure environmental chemicals relevant to firefighting and evaluate their effects on thyroid hormone levels. Methods: We measured 10 FR or their metabolites in urine of female firefighters and office workers from San Francisco: bis(1,3-dichloro-2-propyl) phosphate (BDCPP), bis(2-chloroethyl) phosphate (BCEP), dibutyl phosphate (DBuP), dibenzyl phosphate (DBzP), di-p-cresyl phosphate (DpCP), di-o-cresyl phosphate (DoCP), 2,3,4,5-tetrabromobenzoic acid (TBBA), tetrabromobisphenol-A (TBBPA), 5-OH-BDE 47, and 5-OH-BDE 100. We assessed potential predictors of exposure levels and the association between FR exposures and thyroxine (T4) and thyroid stimulating hormone (TSH). Results: BDCPP, BCEP, and DBuP were the most commonly detected FRs, among all study participants, with intermediate BMI and college educated women having the highest levels, and Black women having higher BDCPP levels than White women. Firefighters had higher detection frequencies (DF) and exposure levels compared to office workers; median BDCPP levels were five times higher in firefighters than in office workers. Among firefighters, occupational activities were not significantly associated with FR levels, although position (i.e. officer and firefighter versus driver), being on-duty (versus off-duty) and assigned to the airport suggested a positive association with FR levels. Among firefighters, a doubling of BDCPP was associated with a 2.88% decrease (95%CI -5.28,-0.42) in T4. We did not observe significant associations between FR and T4 among office workers. Discussion: Firefighters had significantly higher exposures to FR compared to office workers, and we observed a negative association between BDCPP and thyroxine in firefighters. Future research should elucidate occupational sources of FR exposure and opportunities for exposure reduction.

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Cancer risk among career male and female Florida firefighters: Evidence from the Florida Firefighter Cancer Registry (1981‐2014)

Cited by 53 publications

References 60 publications

Comparing cancer risk estimates using occupational record linkage approaches in male Florida firefighters

Comparing cancer risk estimates using occupational record linkage approaches in male Florida firefighters

Impact of select PPE design elements and repeated laundering in firefighter protection from smoke exposure

Organophosphate and organohalogen flame-retardant exposure and thyroid hormone disruption in a cohort of female firefighters and office workers from San Francisco

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