Washington Post writes about firefighters and cancer

Above: Members of a hotshot crew work in smoke on the Cold Brook Prescribed Fire, October 23, 2014. Photo by Bill Gabbert.

Very slow progress is being made toward recognizing the long term health risks of firefighters and more importantly, taking action to mitigate the effects.

This month another bill was introduced that would establish a national cancer registry for firefighters diagnosed with cancer, an occupational hazard that many organizations recognize as a presumptive disease in the profession. The bill is titled Firefighter Cancer Registry Act of 2017. A similar bill with 118 co-sponsors died a quick death in 2016, so there is little hope that this one will fare much better. This newest one has 12 co-sponsors as of today.

On Friday the Washington Post published an in-depth look at the topic in an article titled, Firefighters and cancer: Is a risky job even riskier? The authors interviewed several firefighters who have been diagnosed with cancer and laid out some of the health-related risks of the job.

Here is an excerpt from the article:

In 2015, the Centers for Disease Control and Prevention released the final results of what is currently the largest study of cancer risk among career firefighters ever conducted in the United States. The study of about 30,000 firefighters over a 60-year span showed that compared with the general population, firefighters on average are at higher risk for certain kinds of cancer — mainly oral, digestive, respiratory, genital and urinary cancers.

It is important to provide treatment to firefighters that have been injured on the job, including those suffering from diseases that were likely caused by working in a hazardous environment.

It is also important to take steps to reduce the hazard in the first place. For wildland firefighters who don’t have the luxury of breathing air carried in a bottle on their back, avoiding cancer-causing smoke can be difficult. But in some cases supervisors can minimize the number of firefighters that are forced to work in heavy smoke, or rotate them into areas where there is less. A crew can have a small carbon monoxide detector to identify excessive exposure to the dangerous gas, which on a fire would also be associated with the presence of particulates and carcinogens.

Here is another quote from the Washington Post article:

“Smoke on your gear and smoke on your helmet used to be a sign that you’re an experienced firefighter,” said Lt. Sarah Marchegiani of the Arlington County Fire Department. “But now people just recognize it’s a hazard and not worth it.”

Nevada BLM engine crew
A Nevada BLM engine crew in 2016. Inciweb photo. The faces were blurred by Wildfire Today.

An issue that always creates some controversy on Wildfire Today is the fact that some firefighters feel that refusing to change out of very dirty Nomex even when clean clothes or a laundry service are available proves to their colleagues that they are cool, or experienced, or skilled, or manly. The fact is, the contaminants that accumulate on clothing, personal protective equipment, and line gear are dangerous. Having it in contact with your skin can cause it to be absorbed into the body. If the firefighter’s environment is warm their pores will open which allows chemicals to be absorbed even more quickly. Everybody that is knowledgeable about the issue agrees. Contaminants can even build up to the point where the fire resistance of the fabric is compromised, especially if it includes chainsaw oil or the residue of drip torch fuel.

Firefighter Close Calls reports on injuries and accidents in the fire world and has written about the hazards of contaminated fire gear. Here is an example from earlier this week:

Firefighter Close Calls Tweet

And below is a better photo of the helmet:
Cairns dirty helmet firefighter

The fact that a major manufacturer of personal protective equipment for firefighters uses gear in their advertising that is probably contaminated with carcinogens, is an indicator of the difficulty in solving this health-related problem.

firefighters, cancer,
Screenshot from Jason Curtis’ film about San Diego firefighters and the occurrence of cancer.

Information about the hazards of wood smoke:

Legislation introduced to establish a national firefighter cancer registry

A bipartisan group of 76 Congressional Representatives have signed on as sponsors for legislation that would establish a national cancer registry for firefighters diagnosed with this deadly disease. The bill is titled Firefighter Cancer Registry Act of 2017.

Most firefighters know others in their profession who have suffered from and in some cases died of various forms of cancer.

The British Columbia government recognizes at least nine “presumptive cancers” among firefighters, including leukemia, testicular cancer, lung cancer, brain cancer, bladder cancer, ureter cancer, colorectal cancer, and non-Hodgkins’s lymphoma.

According to Congressmen Bill Pascrell of New Jersey and Chris Collins of New York:

…The creation of this registry would enable researchers to study the relationship between firefighters’ exposure to dangerous fumes and harmful toxins and the increased risk for several major cancers. In the future, this information could also allow for better protective equipment and prevention techniques to be developed.

“Public servants like our firefighters put their lives on the line every day for us,” said Congressman Chris Collins. “Unfortunately, firefighters see a higher rate of cancer than the rest of the public. This legislation will provide the Centers for Disease Control and Prevention (CDC) the tools they need to improve their data collection capabilities on volunteer, paid-on-call, and career firefighters. We hope that by creating a voluntary ‘Firefighter Registry’ that includes the many variables that occur over a firefighter’s career, the CDC will be able to better study this deadly trend. In the future, this information can be used to provide better safeguards and protocols for these brave men and women.”

Research links wildfire smoke with cardiac arrest in men

smoke prescribed fire firefighter
A firefighter is enveloped in smoke while working on a prescribed fire in Hot Springs, SD, March 30, 2013. Photo by Bill Gabbert.

Researchers in Australia have found a link between smoke from bushfires and cardiac arrest in men over 35 in the population of metropolitan Melbourne. We would like to see a study done of wildland firefighters who breathe far more smoke than the residents of Melbourne.

Below is an excerpt from Medicalxpress.com:

Men over 35 have an increased risk of cardiac arrest if exposed to poor quality air from bushfires, a new study has found.

Monash University research using data from Ambulance Victoria’s Victorian Ambulance Cardiac Arrest Registry (VACAR) investigated the links between out-of-hospital cardiac arrests and bushfire smoke exposure in metropolitan Melbourne during the 2006-07 bushfire season.

The study, published in the latest edition of Environmental Health Perspectives, found an association between exposure to forest fire smoke and an increase in the rate of out-of-hospital cardiac arrests.

Monash University researchers led by Dr Martine Dennekamp, Department of Epidemiology and Preventive Medicine, saw greater increases in the number of men over 35 years old experiencing cardiac arrests but did not see a significant association in women over 35.

Dr Dennekamp said exposure to smoke from forest fires was a significant health issue in many countries, and it was important to raise community awareness.

“The problem is likely to get worse in the future, as we can expect fires to become both more frequent and more severe,” Dr Dennekamp said.

The state and federal governments not only employ the most wildland firefighters in the United States, but they would also be the ones to fund research like this. One would think they would have a disincentive to discover environmental conditions on the job that adversely affect the health of their employees. Don’t ask the question if you don’t want to know the answer, right? Mitigating the hazard of smoke for firefighters on a wildfire would be extremely difficult. But the least these employers should do is determine exactly the nature and scope of the hazard, and support their employees, and former employees, who suffer from life threatening diseases caused by their jobs.

There have been some papers written and some research has been completed on wildfire smoke, but what is needed is a thorough long term study on wildland firefighters conducted by epidemiologists. Something we first called for in 2010.

A very well known and respected Hotshot Superintendent advised me to frequently complete a CA-1 accident form after breathing lots of smoke on a fire. If you don’t, perhaps 10, 20, or 30 years later it might be hard to convince your employer that one or more of the following conditions were caused by your job: leukemia, testicular cancer, lung cancer, brain cancer, bladder cancer, ureter cancer, colorectal cancer, and non-Hodgkins’s lymphoma. All of those are recognized by the British Columbia government as an occupational hazard for firefighters; they are called presumptive cancers. But the United States government does not.

Other articles on Wildfire Today tagged cancer and firefighter health.

Study finds firefighters more likely to get two types of cancer

According to a recently published study, firefighters in three major municipal fire departments were more likely to be diagnosed with lung cancer and leukemia than the general population.

Researchers examined the firefighting exposure and medical histories of 20,000 firefighters with over 1,300 cancer-related deaths and 2,600 cancer incidence cases in Chicago, Philadelphia, and San Francisco who were on duty between the years 1950 and 2009. This was one of the largest studies of its kind, and was the first to relate the time elapsed during fire runs to cancer risk.

Among eight types of cancers examined, they found slight, but statistically significant positive exposure–responses for lung cancer and leukemia risk. The researchers wrote:

These findings contribute to the evidence of a causal association between firefighting exposures and cancer.

The study did not address the health effects on wildland firefighters who, unlike structural firefighters, do not have access to an effective breathing apparatus to provide them clean air to inhale into their lungs. There could also be significant differences between the harmful effects of vegetation smoke and that produced by materials in structure fires.

Some wildland firefighters, especially those on hand crews, are routinely exposed to smoke-filled air for hours each day when assigned to a large fire, sometimes for 14 days. At other times they can be stationed in a smoky environment 24 hours a day for weeks at a time when inversions trap smoke. This frequently occurs in northwestern California, for example on the Six Rivers, Klamath, and Shasta-Trinity National Forests. In those cases even non-firefighters working in administrative positions at the Incident Base have been adversely affected by breathing contaminated air.

As we wrote in January, 2011:

There needs to be a concerted effort to conduct a similar study on wildland firefighters. It should be led by a physician/epidemiologist and should evaluate the long term health and occurrence of cancer and other diseases among wildland firefighters. There is a lot of grant money out there and it should be possible to get some of it pointed towards this overlooked niche of firefighting.

Other articles on Wildfire Today tagged cancer and firefighter health.

9/11 health care bill does not cover firefighters’ cancer

Remember the huge battles to get the bill passed to provide health care for the firefighters that were suffering from medical issues after working in the debris from the towers that fell during the 9/11 attacks? Most of us felt a huge relief when the “S. 1334: James Zadroga 9/11 Health and Compensation Act of 2009“ was finally passed. We wrote about it several times, with the latest being HERE.

It turns out that the bill, or at least the way the provisions are being interpreted, does not cover the treatment of cancer for the firefighters that worked on the debris pile. Cancer — you would think this would be close to the number one condition covered for the people that worked in that toxic environment.

John Howard, the World Trade Center Health Program administrator, said in a statement that cancer would not be covered because there is not adequate “published scientific and medical findings” that a causal link exists between September 11 exposures and the occurrence of cancer in responders and survivors. So if we wait, and study the link for another, what, 20 or 30 years we can prove it then?

This is a disgrace.

Jon Stewart of the Daily Show, in a piece named “I Thought We Already Took Care of This S@#t”, expresses his opinion on the issue. The clip has profanity, but it is bleeped out.

NorthJersey.com has more details about this development.

Meanwhile, the Canadian government has a vastly different approach. For years the provinces of Alberta and Manitoba have had presumptive coverage for a list of conditions for firefighters. If they are diagnosed with one of the cancers on the list, it is considered an occupational disease and they may be eligible for workers compensation benefits. In fact, Alberta expanded their list in May to include prostate, breast, skin and multiple myeloma, bringing the total to 14 types covered under the Workers Compensation Board. Their government acknowledges that firefighters are at a greater risk of contracting cancer than the general public, and it can be difficult or impossible to prove that a particular case of cancer was caused by a specific incident or exposure, on or off the job.

The future of wildland fire smoke research

JFSP smoke research planThe Joint Fire Science Program (JFSP) has released their plan for wildland fire smoke research. The 58-page document outlines their priorities for funding smoke research through 2015.

Much of the emphasis appears to be directed at how to deal with the public’s perception and tolerance of smoke. Smoke is becoming an increasingly sensitive subject to the population due to larger wildfires burning for longer periods of time, concern about the effects of wildfire smoke on global warming, and prescribed fires continuing to be an important tool for land managers.

One aspect of wildfire smoke that Wildfire Today has written about frequently is the short and long term effects of smoke on the health of firefighters. On April 23, 2010 we covered the study that NIOSH and the U.S. Fire Administration are conducting about cancer among structural firefighters. We called out the land management agencies and the firefighting associations:

There needs to be a concerted effort to conduct a similar study on wildland firefighters. It should be led by a physician/epidemiologist and should evaluate the long term health and occurrence of cancer and other diseases among wildland firefighters. There is a lot of grant money out there and it should be possible to get some of it pointed towards this overlooked niche of firefighting.

Followups to that article are HERE and HERE.

The JFSP five-year plan does mention research on the effects of smoke on wildland firefighters, but at times it seems like an afterthought. For example, the objective for one of four research themes, “Smoke and Populations”, sometimes includes the “impact of smoke on populations” (page 26), and in other places it is described as “impact of smoke on populations and fire fighters” (page 21).

However, the plan does list some specific “Smoke Science Foci” that may benefit firefighters:

  • 2011: (SSP T3 -2): Epidemiological research/literature review to determine human health risk from high PM loadings.
  • 2011 (SSP T3-4): Fire fighter smoke health hazards: trends in health and exposure.
  • 2012 (SSP T3-5): Review of epidemiological research to determine human health risk from high PM, high ozone and high aromatic hydrocarbon loadings with a focus on synergisms between pollutants.

We hope that the “foci” turns into actual research.