Across the nation, recognizing the need to address the issue of job-related cancer is being embraced by the fire service, as are efforts to prevent the disease by trying to learn more about it and how it affects firefighters. One of those efforts is an ambitious and aggressive research project to study thousands of firefighters over the course of 30 years to identify the factors that lead to increased cases of cancer in the fire service.
The Fire Fighter Cancer Cohort Study (FFCCS) was created in 2016 to help to prevent cancer among firefighters by providing answers to questions about how those cancers develop. The research project is led by the University of Arizona with collaborative support from multiple other research partners, including the University of Miami, the National Institute for Occupational Safety and Health (NIOSH), the National Fallen Firefighters Foundation (NFFF) and Fire Protection Research Foundation. The study is led by Dr. Jeff Burgess of the University of Arizona and Alberto Caban-Martinez, DO, PhD, of the University of Miami. Support is provided by the NFFF, the IAFF, the International Association of Fire Chiefs and the National Volunteer Fire Council, among others.
An expansive project
The FFCCS aims to create and test a nationwide framework to collect epidemiologic surveys, biomarkers and exposure data that focuses on the health effects of firefighters’ exposure to carcinogens. The initial three-year project is underway with a smaller group of firefighters from the Boston, Palm Beach County, FL, and Tucson, AZ, fire departments and the Elephant Head, AZ, and Helmet Peak, AZ, volunteer fire departments. Ultimately, the goal is to develop and grow the study sufficiently to include 10,000 firefighters who will be observed long-term over the course of 30 years.
The research project includes both recruit firefighters as they begin their firefighting career and veteran firefighters who have many years of service and, therefore, exposure. As the FFCCS website (ffccs.org) explains, cancer is one of the leading causes of illness and death in the fire service. A study by NIOSH revealed a higher death rate for cancer in firefighters compared with the rest of society.
Research and evidence has proven over the years that firefighters have been exposed to multiple carcinogens through both inhalation and skin contamination. What currently isn’t understood is which specific exposures cause cancer in firefighters nor the mechanisms by which they do so. More research also is needed into potential methods to reduce these exposures to firefighters.
Research will be conducted on several chemicals that are known to contain human carcinogens. Those chemicals include benzene, formaldehyde and polycyclic aromatic hydrocarbons (PAHs) along with diesel engine exhaust. Halogenated compounds, such as flame retardants, also will be investigated for potential carcinogenic effects on firefighters. Because cancers can take time to detect, researchers must establish biomarkers in firefighters during their career that would measure the effects of the job-related carcinogens. Doing so would monitor the firefighters long before cancer might develop, when interventions to prevent the disease could be more effective.
How the FFCCS works
The initial phase of the research project is organized around four core entities: Oversight and Advisory, Biomarker Assessment, Exposure Assessment and Data Coordination.
The FFCCS Oversight and Advisory Board is composed of individuals who represent firefighter organizations and interests. The board provides scientific guidance and direction on protocols and research for the study. The group also is responsible for leading the long-term effort to recruit 10,000 firefighters into the study over the course of the next three decades.
The Biomarker Assessment Core comprises scientists and firefighters who determine the agenda of what biomarkers must be collected from firefighters and when, to discover changes in the human body around cancer when exposed to specific carcinogens that are in the workplace.
The Exposure Assessment Core examines to what carcinogens firefighters are exposed in the workplace, when they are exposed and in what quantities they are exposed. This core is responsible for designing the logistics and the protocols that are involved for collection of exposure assessment data from firefighters.
The Data Coordination Core provides direction on the epidemiology of the study, including what survey instruments to collect, how to perform the consent process, and integrating all of the data that are collected from the two cores of biomarkers and exposure assessment.
Initial funding for the FFCCS is provided through a three-year Department of Homeland Security FEMA Assistance to Firefighters (AFG) grant.
Early dividends
Burgess noted that early research is paying off with important results. They include identification of fireground interventions (putting engineers on air and entry team washdown before doffing gear) that reduced by more than one-third the amount of combustion products absorbed into the body of firefighters, and that using skin wipes reduces the toxicity of combustion products that are deposited on the skin.
In addition, Burgess says the research “has identified firefighter blood epigenetic markers on cancer-promoting and suppressing genes that are associated with firefighter exposures and increased cancer risk.” He adds that the findings already were used to support the expansion of firefighter cancer-related laws in Arizona and to identify targets for future cancer prevention interventions in firefighters.
As the project continues, he says, researchers are making progress in several areas, including the evaluation of exposures and health effects in fire service trainers, investigators, volunteers and wildland-urban interface firefighters. They are doing so, he says, by measuring environmental contaminants in blood, including perfluoroalkyl and polyfluoroalkyl substances in firefighters from structural and airport firefighters. Other work includes evaluating potential sources of exposure (aqueous film forming foam, fires and turnout gear) and associated toxicity; investigating differences in DNA methylation (and epigenetic marker) in Hispanic and nonminority firefighters, which might help to explain the distinct cancer risks that were seen in previous studies of minority firefighters; and starting a new FEMA grant that evaluates cancer risks in women firefighters and volunteer firefighters.
In addition, the FFCCS serves as the foundation of the Research on the Epidemiology of COVID-19 in Emergency Response and Healthcare Personnel Study (RECOVER). The study is funded by the Centers for Disease Control and Prevention through a partnership with Abt Associates and various U.S. healthcare systems and academic institutions, such as the University of Arizona and the University of Miami. The primary goal of this project is to build on the existing national FFCCS efforts and FFCCS research infrastructure to study COVID-19 specifically among U.S. first responders. The primary research objectives of the RECOVER study are to: determine the frequency of SARS-CoV-2 virus infection and COVID-19 illness among healthcare personnel (HCP) and first responders (FP); and to describe SARS-CoV-2 reinfections among HCP/FR who are seropositive to SARS-CoV-2 and/or documented prior PCR-confirmation of SARS-CoV-2 infection .
Get involved
It is the hope that 10,000 firefighters will be enrolled in the study over the course of the next 30 years. Burgess says that involvement in the FFCCS is based on enrollment within fire departments, “so it’s critical to coordinate with your fire department to be involved. On-boarding a career, volunteer or combination fire department and its firefighters requires individual firefighter champions who can assist with facilitating firefighter participation.”
Most of the FFCCS recruitment has been based on federal funding, but Burgess notes, “We are also exploring with additional fire departments whether we can expand our recruitment through local foundation, state and other donor support.”
About the Author
Ed Klima joined the First Responder Center for Excellence (FRCE) as its first managing director in 2017. He manages the daily activities of the FRCE. Klima is a certified emergency manager who has more than 27 years of public safety experience as a firefighter, hazmat technician, EMT, fire inspector and fire officer. He holds two bachelor’s degrees from the University of Delaware as well as a master’s degree in public safety management from Saint Joseph’s University.
Ed Klima
Ed Klima joined the First Responder Center for Excellence (FRC) as its first managing director in 2017 where he manages the daily activities of the FRC. Klima is a certified emergency manager with more than 27 years of public safety experience as a firefighter, hazardous material technician, EMT, fire inspector and fire officer. Klima holds two bachelor’s degrees from the University of Delaware as well as a master’s in public safety management from Saint Joseph’s University.
