Cancer and the Fire Service

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.

• Wear your self-contained breathing apparatus (SCBA) — As stated above, most fires we face today involve plastics and synthetic, manufactured materials. We encounter them at structure fires, vehicle fires, and dumpster and rubbish fires. Sheds and barns are also storage areas for a variety of household and agricultural chemicals that are toxic when burning. Smoke is toxic. If you are close enough to inhale the smoke, you are inhaling toxic smoke that likely contains carcinogenic compounds. Even though a fire may be fought outside, if you are close enough to the fire to inhale the smoke, you should protect yourself and wear SCBA.
• Wash gear and equipment — The toxic gases and particles released during a fire do not go up in the air and blow away; they can settle in the fabric of your gear and on your equipment. Some view "dirty" gear as a badge of honor, but in reality you are exposing yourself to the same carcinogenic compounds every time you wear that gear. Not only are you exposed to carcinogenic material during the fire, you will keep re-exposing yourself every time you touch the gear. Simply washing your gear after a fire will reduce the exposure you have to carcinogenic substances.
• Take a shower — During a fire, toxic compounds in smoke are released into the air as gas and particulate matter. These substances settle on everything, including your gear and your skin. If your face and hands are covered in soot or you smell like the fire you just fought, there are carcinogenic compounds on your skin and your clothes. For hazmat situations, showering is the last step to decontamination. This should be applied to fires as well; firefighters should shower at the earliest convenient time. This will help decrease the time of exposure to the carcinogenic compounds and minimize the potential of exposing others, such as your family, to the same carcinogenic material.

• Avoid diesel exhaust — Diesel exhaust has long been suspected to cause cancer. Not only is diesel exhaust suspected to cause cancer, it is thought to irritate the lining of the respiratory system and cause asthma, bronchitis and other inflammatory respiratory diseases. Diesel exhaust is a combination of gases and particulate matter. When diesel fuel is burned, it produces polycyclic aromatic hydrocarbons and diesel soot. Both of these substances are classified as carcinogens, or substances that can cause changes in human cells to transform them into cancer cells. Results from epidemiological studies have led the National Institute for Occupational Safety and Health (NIOSH) and the Environmental Protection Agency (EPA) to conclude that diesel exhaust most likely causes cancer. Diesel exhaust is thought to increase the risk of lung, larynx, kidney and bladder cancer. This is important since the majority of fire apparatus are diesel and many stations, especially older ones, may have no exhaust-removal system.

  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.
• Testicular cancer — Testicular cancer usually develops in men between the ages of 20 to 39, although it can occur in adolescents as young as 15. It is usually characterized by a painless lump on a testicle, swelling or fluid in the scrotum, or dull pain in the scrotum, groin or lower abdomen. Early detection is important because finding testicular cancer before it has spread can lead to 100% cure in most cases. It is treated by surgical removal of the affected testicle. Testicular self-exam is key to early detection. All men 15 to 39 should perform this monthly. A physician should also perform it during annual physical exams for the appropriate age group. Ask your healthcare provider how to perform this simple exam.

• Colon cancer — The rate of colon cancer increases after age 50. Colon cancer is usually asymptomatic; unfortunately, when signs or symptoms develop, the disease is usually advanced. Signs and symptoms include changes in bowel habits, bloody stools, change in stool diameter, weakness or cramping abdominal pain. Colon cancers usually develop in polyps, or outgrowths of tissue, on the inside surface of the colon. These polyps are not cancerous, but they have the potential to develop into cancer over time.

  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.

• Prostate cancer — The risk of prostate cancer increases after age 65, but it can develop in men in their 40s. Symptoms are usually related to urination: difficulty starting or stopping urination, weak flow, the inability to urinate or the sensation that you need to urinate constantly. These symptoms are not specific to prostate cancer and are similar for benign prostatic hypertrophy, or an enlarged prostate, that is common with age. There are two main methods of prostate cancer screening: the digital rectal exam (DRE) and a blood test called the prostate specific antigen test (PSA). The DRE is performed in the office and is used to detect abnormal lumps in the prostate gland while the PSA is a blood test that may be elevated if prostate cancer is present. Both tests are used to identify prostate cancer in the early stages while the disease is curable. The American Urological Association recommends that these two screening modalities be used for all men over 50 every year or starting at age 45 in men with a family history of prostate cancer.
• Breast and cervical cancer — Strategies to prevent these two types of cancer have been established for years. It is recommended that all women over 18 perform breast self-exams monthly, and have a physician perform an exam annually. The American College of Obstetricians and Gynecologists (ACOG) recommends mammography every one to two years for women 40 to 49 and annually after 50. The ACOG also recommends Pap smears every two years, extending to every three years under certain conditions.

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.