Firefighter Cancer Rates: The Facts from NIOSH Research

22 comments on “Firefighter Cancer Rates: The Facts from NIOSH Research”

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After I read this article, I got to have knowledge and add my insight, I happened to look for an article like this, it is very helpful for me and the crowd, the writing is good to read and easy to understand.

It is said that Cancer is milestone of related chronic Diseases. Maybe it is most effect solution that health practitioner can help Firefighter to prevent possible professional career caused chronic diseases like stomach ulcer, lack of sleep, health problems caused by long term stress factors. By this way, may be the risk of cancer and other causes of death due to job exposures can be reduced dramatically?
Maxwell Chan

I’m wondering about the accounting of gender in cancer rates here. Males express an average of 207.9 per 100,000 cancer mortality rate and the average population hits 171.2 per 100,000 cancer mortality while women are 145.4 per 100,000 cancer mortality.

If firefighters show a 14% increase over the general population’s cancer mortality rate (171.2/100,000) then that would be a 24 (23.968) per 100,000 increase, putting them at 195.168 per 100,000 firemen.

That rate is actually lower than just the average male’s cancer mortality rate but not by much. When considering that just under 4% of firefighters are female, is it possible that they account for the remaining drop and that firefighters actually express cancer mortality rates at numbers similar to males due to the gender skew to male in the profession?

I mean, of course mesothelioma increased the risk regardless. I’m just wondering if it was controlled for in any of these studies when considering the general population number to compare.

All analyses using the US population as the referent were stratified by gender, race (Caucasian, other races), age (age 15–85+ years in 5-year categories), and calendar year (in 5-year categories). The standardized mortality ratio (SMR) is essentially the number of deaths observed in the study population (i.e., firefighters in our study) divided by the number of deaths expected in the U.S. population of the same distribution of gender, race, age, and calendar period as our study population. The expected deaths are calculated from the referent rates in the now ‘standardized’ population. An SMR that is greater than 1 is said to indicate “excess deaths” in the study population.

we must pay more attention to this situation, because they also risk their lives while working. hopefully there is a new policy related to this research.thanks Eisher

Why are we only tracking mortality? Many firefighters get cancer earlier in life and continue to work but we fail to be tracked- morbidity?

I have directly asked this question of Johns Hopkins researchers and was told, “that’s a different department.”

Researcher are missing firefighter cancers that occur earlier because morbidity is not tracked and these firefighters die outside the tracking. As a result, cancer rates are lower and not related to firefighting.

My father was a 27-year veteran of the Baltimore City Fire Department (BCFD). In 1998, he was diagnosed with stage 4 pancreatic cancer and within 6 months he was dead. I have long believed, as a former oncology R.N., that his fire fighting was a significant cause of his cancer diagnosis and death. Ten years previous to his cancer dx, he also experienced a heart attack and required a CABG, with three arteries involved. He was an active, vibrant man, recovered quite from the CABG, returned to his home projects, vegetable garden and landscaping activities. Even after his retirement from the BCFD, he got another full-time job as a maintenance man at a local hospital, then took classes to qualify as a specialist in the hospital electronic lock system involving computer work. Losing him was a huge loss not only to our family, but to the hospital community and our neighbors and the firefighter community members who knew and loved him.

My husband died in 2016 (age49) from Pancreatic cancer. He was a firefighter/arson investigator for 33 years.. he was diagnosed with testicular cancer in 1997. I also believe his exposure to carcinogen in his career caused the cancer

I am so sorry for your loss. My 48 year old brother, retired after 25 years with the FD and several years as a volunteer FF. Three short years later he was diagnosed with Stage 3 pancreatic cancer. He fought the hardest battle of his life for almost a year before passing in 6/23. His company is fundraising to provide testing for retired firefighters. Hopefully those still working can be tested as well.

My 53 year old brother, a retired firefighter lost his year long battle with pancreatic cancer in June, 2023. I’m not a medical professional, but it seems this happens a lot in the firefighting community. Could it be related to exposure to carcinogens on the job? What can be done to reduce exposure or test to catch the disease in an early stage?

We are very sorry for your loss. Studies show that firefighters may have a greater risk of some types of cancer due to their exposure to smoke and hazardous chemicals on the fireground. In fact, the International Agency for Research on Cancer (IARC) has classified the occupation of firefighting as a known human carcinogen based on sufficient evidence of mesothelioma and bladder cancer in firefighters. IARC also found limited evidence of 5 other cancers (colon, prostate, testicular cancer, melanoma of the skin, and non-Hodgkin lymphoma).
It is important for the Fire Service to educate its members about safe work practices. Effective training promotes a safety culture that cultivates sound work practices. Sound work practices are designed to reduce exposures to hazardous agents, which is key to reducing occupational illnesses, including cancer. Training should emphasize decontamination practices, the proper use and care of PPE and turnout gear, and the proper use of approved respiratory protection during all phases of firefighting. The Fire Service has developed resources such as the Lavender Ribbon Report for communicating best practices in firefighter cancer prevention. You can also consider reaching out to the Firefighter Cancer Support Network | Together we can… to get involved with their organization. They provide occupational-cancer awareness and support for firefighters, including family members of firefighters, affected by cancer.

Dr. Daniels:

I’m very interested in the data you collected from each department individually. I would like to see how data from San Francisco FD compares to that of Chicago and Philadelphia, specifically. Would that be possible? Thank you for your work on this matter.

Thank you for your interest in our research. In addition to the published articles on the NIOSH 3-city study (https://oem.bmj.com/content/oemed/suppl/2013/10/14/oemed-2013-101662.DC1/oemed-2013-101662supp.pdf), there were supplemental data on comparisons between cities that was made available online (https://www.cdc.gov/niosh/firefighters/health.html).

So if 22% of the US population dies of cancer, does this study suggest that 36% (22% + 14%) of firefighters will die of cancer, or that 25% (22% x 1.14) of them will die of cancer?

There are many additional factors that should be considered when predicting lifetime risks; therefore, simple approximations based on estimates from a single observational study are generally not recommended. However for illustrative purposes, if one assumes:
1. The all cancer SMR (i.e., 1.14) is an adequate approximation of the relative risk of cancer death in career firefighters over a lifetime of exposure;
2. The lifetime risk of ever dying from cancer from any cause is 22%;

Then a simple approximation of firefighter lifetime risk of cancer death is 1.14 x 22 = 25 percent. The risk that is attributable to firefighting is the risk in firefighters – the background risk = 25-22 = 3 percent. Thus, in a hypothetical population of 100 career firefighters, 25 are estimated to die from cancer, of which 3 deaths were estimated to result from their exposure.

Of course, more information is needed to make appropriate risk projections for use in risk management decisions. But this example gives the reader some idea on interpreting findings from the study.

Thank you both so much for answering that last question! It means a lot to me. And thank you for your study. I think I will talk with my chief about implementing soap and water scrubdowns prior to removal of our SCBA gear. You guys REALLY seem to be making a difference for many of us with your research and by helping to spread the results. Thank you.

Can you please explain how you calclated the SRRs in Table 4 of your 2014 paper in OEM? Just looking at the SMRs it is very difficult to see how the SRRs were derived, or the estimate of slope and p value.
For example in the case of intestinal and rectal cancers, the SMR is lower in the 0-10y group than in the 30+ y group, yet they both show a negative slope, which is statistically significant.

Both SMRs and SRRs were calculated using the NIOSH LTAS computer program (available here) . A detailed description of the program and the statistical methods for each effect measure are provided in the documentation which is available at: LTAS Manual (https://www.cdc.gov/niosh/ltas/pdf/LTAS-manual-2014.pdf). Please refer Appendix B of the manual for the statistical methods. Although these effect measures are somewhat similar, there are important differences in the standardization of the rates that make comparisons difficult.

Dr Daniels

Has there been any understanding as to a decrease in latency periods in firefighters with the understanding that the inference could suggest that the carcinogenic exposures that firefighters face may lead to a decreased latency period over what is seen in the US population?
Steven Moffatt

The term latency is generally considered as the time that passes between being exposed to an agent that can cause a disease and having symptoms of that disease. The latent period varies by disease type, agent, and exposed persons. In firefighter cancer studies, it is usually estimated as the time from start of employment as a firefighter to time of cancer diagnosis or death. Although latent periods can be examined in some study designs, this has not been an aim of firefighter cancer studies. There is currently no evidence suggesting patterns of cancer latency among firefighters differ greatly from that observed in similarly exposed populations.

Hi, thanks for sharing this. It’s super interesting. I’m working on my MPH and have an interest in first responder health. I’m hoping to focus on this area in my future career. I’m doing a research project on firefighters and cancer risk/mitigation, and in all my research I’m having trouble understanding when epidemiologists really started looking at this topic seriously? I found some studies as far back as the early 90s in my lit review, but the majority seem to be in the 2000s, and most in the last 10-15 years (post 9/11, obviously). Did 9/11 really accelerate this research? One study showed a pretty clear effect for lifetime exposure, with risks increasing for firefighters working more than 30 years in the field. Did your work look at this, or at the difference between volunteer vs career firefighters (where I imagine exposure would vary significantly)?

Thank you for your comment. Epidemiologic studies of firefighters date back to the 1930s (life insurance actuary studies). The “modern era” of these studies began with single department studies mostly between (1950–2000s), meta-analyses beginning in 2006, and large pooled studies (like the NIOSH study) beginning 2013. Interest in the field of Disaster Research increased following 9/11; however, research into cancer among firefighters was well underway prior to the terrorist attacks. A comprehensive review of the relevant literature can be found in “Occupational Exposure as a Firefighter”, which is Volume 132 of the IARC (International Agency for Research on Cancer) Monograph on the Identification of Carcinogenic Hazards to Humans (IARC Publications Website – Occupational Exposure as a Firefighter). IARC concluded that occupational exposure as a firefighter was “carcinogenic to humans” based on “sufficient” evidence for cancer in humans for mesothelioma and bladder cancer.

The NIOSH study did not examine cancer risk among volunteers; however, there is a large study of Australian firefighters that examined cancer mortality and incidence among volunteers (e.g., Glass et al 2017). That study found reduced risk of mortality and cancer incidence among volunteers compared with the general population, which is likely caused by healthy-worker selection. This is an important source of potential bias to consider in studies using external comparisons for estimating the health risk in working populations compared with a different referent population.

If you are interested in research of first responders exposed on 9/11, then please visit our research webpage: Program Research (cdc.gov), Funding Dashboard: Dashboard – WTC Health Program (cdc.gov) and Publications page: Research Publications (cdc.gov). The latter is a searchable bibliography of 9/11-related health effects research.

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