Firefighting and Cancer: A Meta-analysis of Cohort Studies in the Context of Cancer Hazard Identification

DeBono, Nathan L; Daniels, Robert D.; Freeman, Laura E. Beane; Graber, Judith M.; Hansen, Johnni; Teras, Lauren R.; Driscoll, Tim; Kjærheim, Kristina; Demers, Paul A.; Glass, Deborah Catherine; Kriebel, David; Kirkham, Tracy L; Wedekind, Roland; Filho, Adalberto M.; Stayner, Leslie T.; Schubauer‐Berigan, Mary K.

doi:10.1016/j.shaw.2023.02.003

Cited by 14 publications

(26 citation statements)

References 60 publications

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“…Current evidence supports that firefighters have an excess risk and mortality from melanoma compared to the general population 1,2 . Firefighters may be occupationally exposed to ultraviolet radiation from the sun as well as skin cancer‐causing agents such as benzene and polycyclic aromatic hydrocarbons found in flame retardants and combustion by‐products 3 .…”

Section: Introductionmentioning

confidence: 96%

“…Current evidence supports that firefighters have an excess risk and mortality from melanoma compared to the general population. 1,2 Firefighters may be occupationally exposed to ultraviolet radiation from the sun as well as skin cancer-causing agents such as benzene and polycyclic aromatic hydrocarbons found in flame retardants and combustion by-products. 3 In 2022, the International Agency for Research on Cancer (IARC) classified occupational exposure as a firefighter as "carcinogenic to humans" (Group 1), 4 including a positive association between occupational exposure as a firefighter and increased risk of melanoma.…”

Section: Introductionmentioning

confidence: 99%

“…3 In 2022, the International Agency for Research on Cancer (IARC) classified occupational exposure as a firefighter as "carcinogenic to humans" (Group 1), 4 including a positive association between occupational exposure as a firefighter and increased risk of melanoma. 2 A meta-analysis from this IARC working groups reported 19% excess incidence of melanoma among studies of firefighters compared to the uniformed service or working populations, a 27% excess incidence for studies that compared firefighters to the general population, and 36% excess incidence for studies that compared firefighters to all studies combined. 2 The United States Preventive Services Task Force (USPSTF) does not make recommendations for skin cancer screening for the general population based on insufficient evidence for the effectiveness of clinical visual skin examinations.…”

Section: Introductionmentioning

confidence: 99%

“…2 A meta-analysis from this IARC working groups reported 19% excess incidence of melanoma among studies of firefighters compared to the uniformed service or working populations, a 27% excess incidence for studies that compared firefighters to the general population, and 36% excess incidence for studies that compared firefighters to all studies combined. 2 The United States Preventive Services Task Force (USPSTF) does not make recommendations for skin cancer screening for the general population based on insufficient evidence for the effectiveness of clinical visual skin examinations. 5 However, the National Fire Protection Association, which sets firefighter health and safety standards in the United States (US), recommends that firefighters have annual skin examinations from a clinician.…”

Section: Introductionmentioning

confidence: 99%

“…Firefighters may be occupationally exposed to ultraviolet radiation from the sun as well as skin cancer‐causing agents such as benzene and polycyclic aromatic hydrocarbons found in flame retardants and combustion by‐products 3 . In 2022, the International Agency for Research on Cancer (IARC) classified occupational exposure as a firefighter as “carcinogenic to humans” (Group 1), 4 including a positive association between occupational exposure as a firefighter and increased risk of melanoma 2 . A meta‐analysis from this IARC working groups reported 19% excess incidence of melanoma among studies of firefighters compared to the uniformed service or working populations, a 27% excess incidence for studies that compared firefighters to the general population, and 36% excess incidence for studies that compared firefighters to all studies combined 2 …”

Section: Introductionmentioning

confidence: 99%

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Prevalence and predictors of skin cancer screening among a sample of US volunteer firefighters

Shah

Steinberg

Caban‐Martinez

et al. 2023

American J Industrial Med

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BackgroundFirefighters have a higher risk of melanoma incidence and mortality compared to the general population. In the United States (US), the National Fire Protection Association recommends all firefighters receive annual skin cancer screening through visual skin examination by a clinician. However, there is limited information on skin cancer screening practices among volunteer firefighters who comprise two‐thirds of the US fire service.MethodsThis cross‐sectional study of 552 US volunteer firefighters estimated the prevalence of skin cancer screening and evaluated associations with their fire service experience, demographics, sun protection practices, and cancer risk perception.ResultsThe prevalence of receiving skin cancer screening among volunteer firefighters was 26.1% (95% confidence interval [CI]: 22.4, 29.8). The odds of being screened for skin cancer, compared to not being screened, were twice as high for firefighters who used sunscreen (odds ratio [OR]: 2.35, 95% CI: 1.48, 3.73) and who perceived their skin likely to burn with prolonged sun exposure (OR: 1.81, 95% CI: 1.10, 3.00). Older age, some college education, and family history of skin cancer were also positively associated with skin cancer screening. A positive exposure‐response relationship was observed between more monthly firefighting calls and receiving screening. Cancer risk perception was not associated with screening.ConclusionTo our knowledge, this is the first large study to assess skin cancer screening among US volunteer firefighters. Our findings suggest gaps in skin cancer prevention efforts in the volunteer fire service. Additional assessment of skin cancer prevention practices within volunteer fire departments could help address these gaps.

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Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prevalence and predictors of skin cancer screening among a sample of US volunteer firefighters

Shah

Steinberg

Caban‐Martinez

et al. 2023

American J Industrial Med

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Cancer incidence in a cohort of Danish firefighters: An extended long‐term follow‐up 1968–2021

Pedersen,

Petersen,

Andersen

et al. 2024

American J Industrial Med

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ObjectivesTo update and extend the examination of cancer incidence in a cohort of Danish firefighters, now adding 7 years of follow‐up and 2766 additional firefighters. The primary focus was directed toward cancer sites that recently contributed to the hazard evaluation conducted by the International Agency for Research on Cancer (IARC).MethodsThe updated cohort consisted of 11,827 male Danish firefighters who were followed up for cancer from 1968 to 2021. Cohort cancer morbidity was compared with a working population reference group, and standardized incidence ratios (SIR) were used for estimation of relative risks, along with 95% confidence intervals (95% CI).ResultsAmong full‐time firefighters, SIR of skin melanoma was 1.30 (95% CI: 1.02–1.66), and SIR = 1.37 (95% CI: 1.02–1.85) for over 5 years of employment. Slightly positive associations were also observed for cancer of the urinary bladder (SIR = 1.16; 95% CI: 0.93–1.45), prostate (SIR = 1.11; 95% CI: 0.97–1.28), and testis (SIR = 1.11; 95% CI: 0.75–1.63).ConclusionsThis updated study provides evidence indicating an elevated risk of skin melanoma in firefighters. Consistent with IARC's evaluation, we also identified positive associations for urinary bladder, prostate, and testis cancer. In contrast, our findings did not suggest an increased risk of colon cancer, non‐Hodgkin lymphoma, and mesothelioma. The latter may be due to small numbers in our still relatively young cohort. Continuous follow‐up for cancer in firefighters is warranted, including assessment of influence from surveillance bias.

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Firefighting, per‐ and polyfluoroalkyl substances, and DNA methylation of genes associated with prostate cancer risk

Quaid,

Goodrich,

Calkins

et al. 2024

Environ and Mol Mutagen

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Prostate cancer is the leading incident cancer among men in the United States. Firefighters are diagnosed with this disease at a rate 1.21 times higher than the average population. This increased risk may result from occupational exposures to many toxicants, including per‐ and polyfluoroalkyl substances (PFAS). This study assessed the association between firefighting as an occupation in general or PFAS serum levels, with DNA methylation. Only genomic regions previously linked to prostate cancer risk were selected for analysis: GSTP1, Alu repetitive elements, and the 8q24 chromosomal region. There were 444 male firefighters included in this study, with some analyses being conducted on fewer participants due to missingness. Statistical models were used to test associations between exposures and DNA methylation at CpG sites in the selected genomic regions. Exposure variables included proxies of cumulative firefighting exposures (incumbent versus academy status and years of firefighting experience) and biomarkers of PFAS exposures (serum concentrations of 9 PFAS). Proxies of cumulative exposures were associated with DNA methylation at 15 CpG sites and one region located within FAM83A (q‐value <0.1). SbPFOA was associated with 19 CpG sites (q < 0.1), but due to low detection rates, this PFAS was modeled as detected versus not detected in serum. Overall, there is evidence that firefighting experience is associated with differential DNA methylation in prostate cancer risk loci, but this study did not find evidence that these differences are due to PFAS exposures specifically.

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Firefighting and Cancer: A Meta-analysis of Cohort Studies in the Context of Cancer Hazard Identification

Cited by 14 publications

References 60 publications

Prevalence and predictors of skin cancer screening among a sample of US volunteer firefighters

Prevalence and predictors of skin cancer screening among a sample of US volunteer firefighters

Cancer incidence in a cohort of Danish firefighters: An extended long‐term follow‐up 1968–2021

Firefighting, per‐ and polyfluoroalkyl substances, and DNA methylation of genes associated with prostate cancer risk

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