Firefighters and cancer: where are we and where to now?

Our plain-English summary of Firefighters and cancer: where are we and where to now?, by L. Fritschi, D.C. Glass (Occupational and Environmental Medicine, 2014).

The study

• Authors: L. Fritschi, D.C. Glass
• Journal: Occupational and Environmental Medicine
• Published: 2014;71(8):525-6
• Type of article: Comment
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This commissioned commentary discussed two recently published cancer incidence cohort studies of firefighters. One used employment records from three US cities linked with cancer and death registries. The other drew firefighters from census data in five Nordic countries linked with national cancer registries. Both found small but statistically significant increases in all cancers (SIR 1.10, 95% CI 1.07 to 1.13, in the US study; 1.06, 95% CI 1.02 to 1.11, in the Nordic study). Both also found an increase in mesothelioma: SIR 2.29 (95% CI 1.60 to 3.19) in the US study and 1.55 (95% CI 0.90 to 2.48) in the Nordic study. The authors attributed this likely to asbestos exposure when buildings burn and during clean-up, and perhaps to asbestos protective gear formerly worn by firefighters. They noted that asbestos remaining in old buildings will continue to expose firefighters. Both cohorts showed decreased testicular cancer risk, which the authors suggested may be chance. Neither showed the increased non-Hodgkin lymphoma risk seen in earlier meta-analyses. Both showed increased prostate cancer and melanoma. The authors related inconsistencies to differing and changing exposures, since no study had assessed individual exposures. They recommended protective clothing and respiratory protection and avoiding skin contact. They concluded that the studies strengthened evidence for increased prostate cancer and mesothelioma risks, and that prevention will depend on better exposure data.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was a commissioned commentary, not a new study. The authors discussed two recent cohort studies of cancer in firefighters. One followed firefighters from three US cities (San Francisco, Chicago and Philadelphia) employed from the 1950s. The other drew on census data from five Nordic countries, covering firefighters from the 1960s. Both found small increases in all cancers combined (standardised incidence ratio, or SIR, 1.10, 95% CI 1.07 to 1.13, in the US study; 1.06, 95% CI 1.02 to 1.11, in the Nordic study). For mesothelioma, the SIR was 2.29 (95% CI 1.60 to 3.19) in the US study and 1.55 (95% CI 0.90 to 2.48) in the Nordic study. The authors suggested this was likely due to asbestos exposure when buildings burn, during clean up, and perhaps from asbestos protective gear. Both cohorts showed increased prostate cancer and melanoma, and decreased testicular cancer; the authors said the testicular decrease may be chance. They concluded the studies strengthened evidence of increased prostate cancer and mesothelioma risks. They added that neither cohort, nor earlier studies, could assess specific exposures for individual firefighters.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Commissioned commentary discussing two recently published cohort studies of cancer in firefighters (not original research)
• Who was studied: As described by the commentary: a US cohort of firefighters from three cities (San Francisco, Chicago and Philadelphia), based on employment records and linked to cancer and death registries, and a Nordic cohort drawn from census data in five countries and linked to national cancer registries. Firefighters were employed from the 1950s (US) and 1960s (Nordic).
• Exposure: Firefighting in general. For mesothelioma, the authors suggested asbestos exposure when buildings burn, during clean up, and perhaps from asbestos protective gear once widely worn by firefighters. Fiber types were not specified.
• Main results:
  • All cancers combined, as reported in the two cohorts: SIR 1.10 (95% CI 1.07 to 1.13) in the US study and 1.06 (95% CI 1.02 to 1.11) in the Nordic study
  • Mesothelioma: SIR 2.29 (95% CI 1.60 to 3.19) in the US study and 1.55 (95% CI 0.90 to 2.48) in the Nordic study
  • Testicular cancer was decreased in both cohorts: SIR 0.51 (95% CI 0.23 to 0.98) in the Nordic study with 9 cases, and 0.62 (95% CI 0.36 to 0.99) in the US study with 15 cases. The authors said these may be chance events.
  • Non-Hodgkin lymphoma was not increased in the two cohorts: US standardised mortality ratio 1.17 (0.97 to 1.40) and SIR 0.99 (0.84 to 1.15); Nordic SIR 1.04 (0.83 to 1.29)
  • Prostate cancer was increased in both new cohorts. In the US cohort the increase was restricted to the San Francisco department and to non-European Americans.
  • Melanoma, not increased in earlier meta-analyses, was increased in both cohorts
• The authors' conclusion: The authors concluded that the two studies strengthened the evidence of increased risks of prostate cancer and mesothelioma in firefighters. They said future prevention will depend on building better exposure data into the research.
• Limitations the authors state:
  • Neither of the two cohorts, nor any of the previous studies, had been able to assess specific exposures for individual firefighters in the cohort
  • Testicular cancer is rare, and case numbers in the cohorts and meta-analyses were relatively small

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Respirator.

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