Surveillance of cancer risks for firefighters, police, and armed forces among men in a Canadian census cohort

Harris, Marianne; Kirkham, Tracy L; MacLeod, Jill; Tjepkema, Michael; Peters, Paul A.; Demers, Paul A.

doi:10.1002/ajim.22891

Cited by 24 publications

(49 citation statements)

References 36 publications

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“…Since firefighters need to pass regular medical check-ups throughout their employment it cannot be ruled out that skin cancer has been more easily detected among firefighters than in the general population, although the check-ups do not specifically include cancer screening. Our finding that firefighters with long work duration have an increased risk of prostate cancer is in line with findings from several studies which found that firefighters have an increased risk of prostate cancer or that prostate cancer risk is associated with longer service (Glass et al 2016;Harris et al 2018;LeMasters et al 2006;Petersen et al 2018a;Jalilian et al 2019). A review and meta-analysis on prostate cancer among firefighters showed small, but statistically significant excesses (Sritharan et al 2017).…”

Section: Discussionsupporting

confidence: 91%

Cancer incidence among Swedish firefighters: an extended follow-up of the NOCCA study

Bigert

Martinsen

Gustavsson

et al. 2019

Int Arch Occup Environ Health

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Objectives To evaluate cancer incidence among Swedish firefighters and analyze risk in relation to work duration as a proxy for cumulative exposure. Methods This cohort study is based on the Swedish component of the Nordic Occupational Cancer (NOCCA) project. The cohort includes six million people who participated in one or more of the population censuses in 1960, 1970, 1980 and 1990. The census data were linked to the Swedish Cancer Registry for the 1961-2009 period, extending a previous NOCCA follow-up time by 4 years. We identified 8136 male firefighters. SIRs were calculated using cancer incidence rates in the national population as a reference. Results We found a statistically significant excess of non-melanoma skin cancer (SIR = 1.48, 95% CI 1.20-1.80) but no positive relationship between risk and work duration. There was a small, yet statistically significant increased risk of prostate cancer among firefighters with service times of 30 years or more. The first follow-up period (1961-1975) showed an increased risk of stomach cancer relative to the reference group, while the last period (1991-2009) showed an increased risk of non-melanoma skin cancer. There was no excess risk for all cancer sites combined (SIR = 1.03, 95% CI 0.97-1.09). Conclusions Our results do not support an overall risk of cancer among Swedish firefighters, but a possible risk of nonmelanoma skin cancer exists. The previously noted excess of prostate cancer among Swedish firefighters in NOCCA was no longer statistically significant in this extended follow-up but was present among those with the longest service times.

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Section: Discussionsupporting

confidence: 91%

Cancer incidence among Swedish firefighters: an extended follow-up of the NOCCA study

Bigert

Martinsen

Gustavsson

et al. 2019

Int Arch Occup Environ Health

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“…In 2007, an International Agency for Research on Cancer (IARC) working group reported elevated summary relative risk estimates for testicular cancer, prostate cancer and non-Hodgkin's lymphoma (NHL) in a meta-analysis of cancer in firefighters and concluded, based on limited evidence, that occupational exposure as a firefighter is possibly carcinogenic to humans (ie, categorised as Group 2B) 1. The literature includes several studies published since the IARC monograph 2–16. Nevertheless, findings still differ among specific cancer sites; perhaps from heterogeneity in exposures, work practices, personal protective equipment use or simply from chance alone 17…”

Section: Introductionmentioning

confidence: 99%

Mortality in a cohort of US firefighters from San Francisco, Chicago and Philadelphia: an update

et al. 2020

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ObjectivesTo update the mortality experience of a previously studied cohort of 29 992 US urban career firefighters compared with the US general population and examine exposure-response relationships within the cohort.MethodsVital status was updated through 2016 adding 7 years of follow-up. Cohort mortality compared with the US population was evaluated via life table analyses. Full risk-sets, matched on attained age, race, birthdate and fire department were created and analysed using the Cox proportional hazards regression to examine exposure-response associations between select mortality outcomes and exposure surrogates (exposed-days, fire-runs and fire-hours). Models were adjusted for a potential bias from healthy worker survivor effects by including a categorical variable for employment duration.ResultsCompared with the US population, mortality from all cancers, mesothelioma, non-Hodgkin's lymphoma (NHL) and cancers of the oesophagus, intestine, rectum, lung and kidney were modestly elevated. Positive exposure-response relationships were observed for deaths from lung cancer, leukaemia and chronic obstructive pulmonary disease (COPD).ConclusionsThis update confirms previous findings of excess mortality from all cancers and several site-specific cancers as well as positive exposure-response relations for lung cancer and leukaemia. New findings include excess NHL mortality compared with the general population and a positive exposure-response relationship for COPD. However, there was no evidence of an association between any quantitative exposure measure and NHL.

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“…The WTC combined Rescue/Recovery cohort includes firefighters, law enforcement and construction workers. An increased risk of melanoma has consistently been reported in previous studies of firefighters (Casjens et al, 2020) and police officers (Finkelstein, 1998, Forastiere et al, 1994, Harris et al, 2018, while results of studies of construction workers are mainly negative (Alicandro et al, 2020, Gallagher et al, 1987, Hakansson et al, 2001, Robinson et al, 1995. Workplace exposure to UV radiation has been suggested to explain these findings, since other occupational groups with opportunity of UV exposure, such as offshore workers (Stenehjem et al, 2017), airline pilots and cabin crews (Sanlorenzo et al, 2015), and agricultural workers (Kachuri et al, 2017) also experience an increased incidence of melanoma.…”

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confidence: 83%

Temporal Aspects of the Association between Exposure to the World Trade Center Disaster and Risk of Skin Melanoma

Boffetta

Goldfarb

Zeig‐Owens

et al. 2021

Preprint

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Rescue/recovery workers who responded to the World Trade Center (WTC) attacks on 9/11/2001 were exposed to known/suspected carcinogens. Studies have identified an increased risk of skin melanoma in this population, but the temporal aspects of the association have not been investigated. A total of 44,540 non-Hispanic White workers from the WTC Combined Rescue/Recovery Cohort were observed between 3/12/2002 and 12/31/2015. Cancer data were obtained via linkages with 13 state registries. Poisson regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI), using the New York State population as reference; change points in the HRs were estimated using profile likelihood. We observed 247 incident cases of skin melanoma. No increase in incidence was detected between 2002 and 2004. Beginning in 2005, the HR was 1.34 (95% CI 1.18-1.52). A dose-response relationship was observed according to time worked on the WTC effort. Risk of melanoma among non-Hispanic White WTC rescue/recovery workers was elevated, beginning in 2005. While WTC-related exposure to ultraviolet radiation or other agents might have contributed to this result, exposures other than the WTC effort and enhanced medical surveillance cannot be discounted. Our results support the continued surveillance of this population for melanoma.

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Surveillance of cancer risks for firefighters, police, and armed forces among men in a Canadian census cohort

Abstract: Canadian firefighters, police, and armed services, may be at an increased risk of developing certain cancers. Results suggested that a healthy worker effect may influence risk estimates.

Cited by 24 publications

References 36 publications

Cancer incidence among Swedish firefighters: an extended follow-up of the NOCCA study

Cancer incidence among Swedish firefighters: an extended follow-up of the NOCCA study

Mortality in a cohort of US firefighters from San Francisco, Chicago and Philadelphia: an update

Temporal Aspects of the Association between Exposure to the World Trade Center Disaster and Risk of Skin Melanoma

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