Fire Fighter Cancer Awareness Month

Week 1: The Scope of the Cancer Problem in the Fire Service

The first week of the Fire Fighter Cancer Awareness Month addresses why cancer is the number-one line-of-duty death in the fire service. Additionally, the content defines cancer, explains the scope of occupational cancer in the fire service and identifies carcinogens, occupational exposures, and other chemicals found in products of combustion (smoke, etc.).

To get the most from this week, we recommend taking one day this week to conduct a Safety Stand Down. All resources are also available to review at your convenience.

• Personal Story:
  Firefighters battle a fearsome occupational hazard: Cancer: (NEW) CBS News report: Since 2002, almost two out of every three fire fighters who died on the job died of cancer, as smoke from today’s fires produces an ever-more toxic brew of chemicals. But many first responders diagnosed with cancer are being denied workers’ comp benefits.
• IARC Reclassification for Firefighting:
  An International Agency for Research on Cancer (IARC) study has reclassified the occupation of firefighting to the highest hazard category: Group 1, “carcinogenic to humans.” The previous study, conducted by IARC in 2007, had classified firefighting as Group 2B, “possibly carcinogenic to humans.”
• Research:
  • Mortality and Cancer Incidence in a Pooled Cohort of United States Firefighters: This study took place between 1950-2009 and included nearly 30,000 professional fire fighters from departments in San Francisco, Philadelphia, and Chicago. This research is the first of its kind to reveal the evidence of firefighting and an increased risk of solid cancers and mesothelioma. 
  • Circadian Rhythm in Prostate Cancer: Time to Take Notice of the Clock (NEW)
  • Research on Elevated Cancer Types for Firefighters (NEW): New research on cancer types found to be elevated in the fire service.
  • Harvard Medical School’s “Fatigue Management in First Responders”: The cumulative effects of sleep loss and sleep disorders represents an underrecognized public health problem and have been associated with a wide range of health consequences including an increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke.
• Educational Presentation:
  • Module 1: The Scope of the Fire Service Cancer Problem (UPDATED for 2023): This PowerPoint presentation describes the scope and trends for the occupational cancer trends in fire fighters. Note: Make sure you view the presentation in “presenter mode” to capture the instructor notes for the slides. 
    
• Prevention Practices: 
  • Wellness and Fitness Programs: IAFF Wellness-Fitness Initiative
  • Annual Physical Exams:
    • Women Firefighter Comprehensive Physical Exam Template
    • Letter to PCP and Recommended Tests/Exams
  • Proper Nutrition: Harvard University’s Dr. Stefanos Kales’ “Feeding America’s Bravest” and the Mediterranean Diet 
• Leadership/Survivorship:
  
  • “Chief, I Have Cancer”: CEO of FCSN Bryan Frieders discusses the importance of being prepared as a leader to properly support colleagues diagnosed with cancer.
• Video Resources:
  • Early Detection Video AAD/Dr. Kannler (NEW)
  • PBS News Hour: How firefighters’ life-saving work puts them at a higher risk of cancer (New)
  • Firefighter Cancer Support Network 2022 (New)
• Survivor Stories:
  • Brad Blakenley (NEW)
  • Brent Nogle (NEW)
• Factsheets:
  • IARC Firefighting Exposure Reclassification (NEW)
  • Fire Fighter Cancer Presumptive Legislation 101 (NEW)
  • Cancer 101
  • Female Fire Fighters and Cancer (UPDATED)
  • Carcinogenic Exposures
  • Cancer Disparities Among Fire Fighters by Race and Ethnicity
• Training Briefs:
  • The Scope of Firefighter Occupational Cancer
• Podcast 1:
  • Firefighters Attacking the Cancer Epidemic (FACE) Teams: Sam Eaton (Palm Beach County, FL Local 2928 [retired]) and Chris Bator (Metro-Broward, FL Local 3080) from the Florida Firefighters Safety and Health Collaborative discuss how cancer in the fire service has impacted their departments and how this led to the creation of Firefighters Attacking the Cancer Epidemic “FACE” Teams.

Week 2: Scientific Research Related to Occupational Cancer

With an understanding of cancer in the fire service, use this week to explore scientific research that identifies the link between occupational exposures and cancer rates among fire fighters. Additionally, this week looks at research on screening for cancer and exposure routes.

To get the most from this week, we recommend taking one day this week to conduct a Safety Stand Down. All resources are also available to review at your convenience.

• Personal Story: Goodyear, AZ Local 4005 member Austin Peck shared his story before he passed away from occupational cancer at age 35.  LODD 2019. (NEW)
• Video: Cancer in the Boston Fire Department (NEW)
• Research:
  • Cancer Risk Among Firefighters: Review and Metanalysis of 32 Studies by Dr. Grace LeMasters: The results of this research confirm previous findings of an elevated risk for multiple myeloma among fire fighters. In addition, a probable association with non-Hodgkin lymphoma, prostate, and testicular cancer was demonstrated.
  • WHO classifies diesel exhaust as a group one carcinogen
• Educational Presentations (Note: Make sure you view the presentation in “presenter mode” to capture the instructor notes for the slides):
  • Module 2: Scientific Research Related to Occupational Cancer (UPDATED for 2023)
    This PowerPoint presentation reviews the results from four key fire fighter cancer research projects.
  • Module 6: The Scope of Occupational Cancer Among Female Firefighters (NEW)
• Survivor Stories:
  • Wendy Watkins (NEW)
  • Jonathan Clarke (NEW)
• Leadership/Survivorship:
  • Cancer Survivor and Retired Fire Fighter Steve Weissman’s article “Leadership Guide to Cancer” from Firefighter Nation (NEW)
• NFORS Tracker App: Following fire activities, exposure reporting is necessary to document exposures that can lead to occupational diseases and cancer. The National Fire Operations Reporting System (NFORS) Exposure Tracker is available as an app for fire fighters, paramedics or officers to log exposure and incident details in a private, encrypted, and secure online environment. The information gathered will help researchers better understand toxic exposures on the fire scene and develop new treatments and prevention protocols for occupational diseases, including cancer. Download the NFORS Exposure Tracker App by going to the app store on your mobile device.
• Factsheets: 
  • Exposures to Carcinogens
  • Turnout Gear Issues and Female Fire Fighters (NEW)
  • PFAS and the Fire Service (NEW)
  • The Importance of Exposure Reporting
• Podcast 2:
  • PFAS Concerns: Jason Burns (Fall River, MA Local 1314) and IAFF Chief Science Advisor Derek Urwin (Los Angeles County, CA Local 1014) discuss per- and polyfluoroalkyl substances (PFAS) – a class of toxic chemicals fire fighters are exposed to. They highlight the concerns for fire fighters and the impact on departments.

Week 3: Prevention, Education, and Best Practices

Turn knowledge into action. Cancer is a big issue facing the fire service, but you can prevent or limit your exposure to carcinogens. This week addresses best practices that should be followed on the fire ground, at the station, and in your personal lives. They include on-scene gross decontamination, the clean cab concept, and modifiable risk factors.

To get the most from this week, we recommend taking one day this week and conduct a Safety Stand Down. All resources are also available to review at your convenience

• Cancer Prevention in Action:
  • San Antonio Texas made a commitment to reducing exposures on the fireground. 
  • Pasco County Florida Decontamination Program (NEW)
  • FCI Clean Your Gear Video 
    Firefighter Cancer Initiative (FCI), in partnership with the Sylvester Comprehensive Cancer Institute and the Florida Firefighter Safety and Health Collaborative, discusses the importance of decontaminating fire fighter gear after making a fire emergency service call. In this video, the team talks about best practices for the decon process and how cleaning gear can reduce cancer risk. 
  • PFAS in Bunker Gear (NEW)
    NBC News report with IAFF regarding PFAS in PPE. 
    
• Research:
  • Contamination of Firefighter Personal Protective Equipment and Skin and the Effectiveness of Decontamination Procedures by Dr. Kenneth Fent: This study provides a greater understanding of the exposure pathways associated with firefighting and the measures that can be implemented to reduce these exposures.
    
  • Evaluation of Interventions to Reduce Firefighter Exposures by Dr. Jeffery Burgess (NEW): This study looks at the effectiveness of sauna use for further decontamination techniques. Further studies need to be undertaken to evaluate this.
  • Another Pathway for Firefighter Exposure to Per- and Polyfluoroalkyl Substances: Firefighter Textiles by Dr. Graham Peaslee (NEW): This study examines PFOAs in fire fighters’ PPE ensemble.
• Educational Presentation:
  • Module 3: Occupational Cancer Prevention (UPDATED): This presentation discusses cancer prevention for fire fighters including contamination risks, modifiable risk factors and tips for keeping a clean cab. Note: Make sure you view the presentation in “presenter mode” to capture the instructor notes for the slides. 
    
• Survivor Stories:
  • FCSN Mentor Video 2023 (NEW): Firefighters diagnosed with occupational cancer describe the mentoring they received from the FCSN and how helpful the program truly is.
  • Caylie Valenta Caretaker Story (NEW): Caylie Valenta describes how difficult it can be to care for a loved one who has occupational cancer as her husband succumbed to this deadly disease. Caylie has also started a nonprofit foundation aimed at early detection for members of the fire service.
• Early Detection (NEW):
  • Lead from Behind: Brooks Belland and the Colorectal Cancer Alliance (the Alliance) announced the launch of “LEAD FROM BEHIND’” with help from Ryan Reynolds and Rob McElhenney. LEAD FROM BEHIND is a new initiative to raise awareness that colon cancer is The Preventable Cancer.
  • DetecTogether: If you treat possible cancer symptoms like an emergency, it might not become one. Know your body and know when to get checked out. DetecTogether and Jason Patton team up for early detection awareness videos.
    • Check Exhaustion
    • Check Cough
    • Check Skin
    • Be Honest With Your Doctor and Speak Up
  •  CalDerm Skin Cancer Screening Plan: California Society of Dermatology and Dermatologic Surgery (CalDerm), the leading voice for dermatologists, announced the launch of the Firefighter Skin Cancer Prevention Screening Program in California in partnership with the Firefighter Cancer Support Network.
• Leadership/Survivorship:
  • American Cancer Society: Survivorship Programs in Your Area: The American Cancer Society has many resources that help support people with cancer and their loved ones. And best of all, our help is free. We can connect you with these resources, whether you are a cancer patient, caregiver of a person with cancer, community leader or volunteer, health care professional or someone who wants to know about programs and services. We can also help you find other free or low-cost resources available. 
• Factsheets:
  • Fire Station Design: Best Practices to Reduce Exposures
  • Self-Contained Breathing Apparatus (SCBA) Through Overhaul
  • Clean Cab Concept
  • Modifiable Risk Factors
  • Reduce Your Exposure to Carcinogens
  • Post-Fire Suppression Interventions to Reduce Exposures
  • Training Brief: Modifiable Risk Factors 
  • Cancer Screenings
• Podcast 3: 
  • Cancer Prevention and Early Detection: Firefighter Cancer Support Network (FCSN)’s Russ Osgood and DetecTogether’s Heather Maykel discuss how fire fighters can be their own advocate and how they can detect cancer earlier by utilizing the DetecTogether program. Russ and Heather explain some of the educational components of the training and tools to advocate for additional screenings.

Week 4: Leadership, Survivorship, and Culture Change

Fire Fighter Cancer Awareness Month is nearing the end, but the work does not stop when January is over! Week four helps guide you through how to support your fellow brothers and sisters who have been diagnosed with cancer and provide resources to assist with organizational culture change that favors cancer prevention practices and how to get support from leadership.

Week four includes two separate sections of information: one for Leadership and Survivorship, and one for Culture Change.

To get the most from this week, we recommend taking one day this week and conduct a Safety Stand Down. All resources are also available to review at your convenience.

Leadership and Survivorship

• Personal Story: “When I Retire”: Boston Fire Department recruits talk about their future. 
• Research:
  • Cancer Incidence Among Firefighters: 45 Years of Follow-Up in Five Nordic Countries 
    The five Nordic countries that participated in this project were Norway, Iceland, Sweden, Finland and Denmark. They studied 16,422 fire fighters and found elevated cancer rates for seven types of cancers. Some of these associations have been observed previously, and it was found that exposure to polycyclic aromatic hydrocarbons, asbestos and shiftwork involving disruption of circadian rhythms may partly explain these results. Although this specific research project was focused on predominantly white male fire fighters, there is a need and a plan to include research for a diversified workforce. This includes and identifies a variety of risks and challenges for diverse ethnic groups and female fire fighters.  
• Educational Presentation:
  • Module 4: Survivorship (UPDATED for 2023): This presentation shares specific strategies for supporting a fire fighter who has been diagnosed with cancer. Note: Make sure you view the presentation in “presenter mode” to capture the instructor notes for the slides. 
• Survivor Stories:
  • Ryker Haseldon (NEW)
  • Kirk Tobiassen (NEW)
• Leadership/Survivorship:
  • University of Miami Firefighter Cancer Initiative Education and Survivorship Program
  • FCSN and Survivorship: Since our founding in 2005, FCSN has been all about providing assistance and support to cancer-stricken firefighters and their families. The FCSN Mission: To assist firefighters and EMS providers and their immediate families diagnosed with cancer by providing badge to badge support,training, and guidance. The FCSN Vision: To be the global leader in firefighter cancer support, awareness, and education.
• Video Resource:
  • PFAS in PPE
• Factsheets:
  • Occupational Cancer and Behavioral Health
  • Survivorship
  • Pregnancy and Firefighting (NEW)
• Training Brief:
  • Survivorship
• Podcast:
  • Cancer Resources for Fire Fighters: Firefighter Cancer Support Network (FCSN)’s Chief Operations Officer Joe Schumacher and the American Cancer Society (ACS) Senior Director of Field Corporate Strategy and Operations Kim Bruna highlight the cancer resources available for fire fighters through their partnerships with the IAFF. They highlight online resources, hotlines, and support services both organizations offer, and how those who are diagnosed with cancer or know someone who is diagnosed can access those resources.

Culture Change

• Cancer Prevention:
  • Firefighter Cancer Initiative: “Clean Your Gear”: Sylvester Comprehensive Cancer Center of Miami and the Firefighter Cancer Initiative highlight the importance of cleaning all PPE to reduce your exposure to harmful carcinogens.areer and volunteer, active, and retired — should consider participating in the NFR. This includes fire fighters who have never received a cancer diagnosis, previously had cancer, or currently have cancer. 
• National Firefighter Registry Informational Video (NEW)
  The National Firefighter Registry (NFR) will be used to track and analyze cancer trends and risk factors among the U.S. fire service to help the public safety community, researchers, scientists, and medical professionals find better ways to protect those who protect our communities and environment.
• Research:
  • Fire Service Organizational-Level Characteristics Are Associated with Adherence to Contamination Control Practices in Florida Fire Departments: Evidence From the Firefighter Cancer Initiative (NEW)
    This study attempts to characterize the types of contamination control practices followed by Florida state fire departments and examine the association between fire department organizational-level characteristics and adherence to contamination control practices.
  • Firefighter Cohort Study: Established in July 2016, the FEMA-funded Fire Fighter Cancer Cohort Study (FFCCS) research project provides a national framework to collect and integrate firefighter epidemiologic surveys, biomarkers, and exposure data focused on carcinogenic exposures and health effects. The long-term goal is to follow 10,000 firefighters over a 30-year observation period.
• Educational Presentation:
  • Module 5: The Need for Culture Change (UPDATED for 2023): A PowerPoint presentation describing the reason a culture change is needed for fire fighter health, safety, and cancer prevention. Note: Make sure you view the presentation in “presenter mode” to capture the instructor notes for the slides. 
• Survivor Story:
  • Gina Burke (NEW)
• Leadership/Survivorship:
  • Executive Officer Leadership: Firefighters and the Cancer Threat: A short article in the International Association of Fire Chiefs about leadership and the issue of fire fighter cancer prevention.  
• Factsheets: 
  • Training Brief: Occupational Cancer and Culture Change 

Factsheets (NEW for 2023)

Research (NEW for 2023)

Factsheets: Firefighter Cancer Types 

Research on different cancer types that firefighters have an elevated risk for.

Center for Fire, Rescue & EMS Health Research, NDRI-USA, Inc.

Authors: Walker S. Carlos Poston, Ph.D., M.P.H., FACE; Sara A. Jahnke, Ph.D., FACE; Maria DH Koeppel, Ph.D.; Christopher K. Haddock, Ph.D., PStat®

1. Occupational Epidemiology Overview
2. Firefighters and Bladder Cancer
3. Firefighters and Brain Cancer
4. Firefighters and Breast Cancer
5. Firefighters and Cervical Cancer
6. Firefighters and Colorectal Cancer
7. Firefighters and Esophageal Cancer
8. Firefighters and Kidney Cancer
9. Firefighters and Lung Cancer
10. Firefighters and Melanoma
11. Firefighters and Mesothelioma
12. Firefighters and Multiple Myeloma
13. Firefighters and Non-Hodgkins Lymphoma
14. Firefighters and Prostate Cancer
15. Firefighters and Testicular Cancer
16. Firefighters and Thyroid Cancer

Recommended Research Studies (Free):

1. Andrew P.W. Banks, Xianyu Wang, Michelle Engelsman, Chang He, Andres F. Osorio, Jochen F. Mueller. Assessing decontamination and laundering processes for the removal of polycyclic aromatic hydrocarbons and flame retardants from firefighting uniforms. Environmental Research March 2021.
2. Tiwari S, Sapkota N, Han Z. Effect of fasting on cancer: A narrative review of scientific evidence. Cancer Science August 2022.
3. Fent KW, Toennis C, Sammons D, Robertson S, Bertke S, Calafat AM, Pleil JD, Geer Wallace MA, Kerber S, Smith DL, Horn GP. Firefighters’ and instructors’ absorption of PAHs and benzene during training exercises. International Journal of Hygiene and Environmental Health June 2019.
4. Goodrich JM, Calkins MM, Caban-Martinez AJ, Stueckle T, Grant C, Calafat AM, Nematollahi A, Jung AM, Graber JM, Jenkins T, Slitt AL, Dewald A, Cook Botelho J, Beitel S, Littau S, Gulotta J, Wallentine D, Hughes J, Popp C, Burgess JL. Per- and polyfluoroalkyl substances, epigenetic age and DNA methylation: a cross-sectional study of firefighters. Epigenomics 2021.
5. Dobraca D, Israel L, McNeel S, Voss R, Wang M, Gajek R, Park JS, Harwani S, Barley F, She J, Das R. Biomonitoring in California firefighters: metals and perfluorinated chemicals. Journal of Occupational and Environmental Medicine. January 2015.
6. Sara A. Jahnke, Ph.D., Nattinee Jitnarin Ph.D., Christopher M. Kaipust, Ph.D., M.P.H. Brittany S. Hollerbach, Ph.D. Brittni M. Naylor, Ph.D., M.P.H., Carolyn Crisp, M.P.H. Fireground Exposure of Firefighters: A Literature Review NFPA May 2021.
7. Sritharan J, Kirkham TL, MacLeod J, et al Cancer risk among firefighters and police in the Ontario workforce. Occupational and Environmental Medicine 2022.
8. Young AS, Sparer-Fine EH, Pickard HM, Sunderland EM, Peaslee GF, Allen JG. Per- and polyfluoroalkyl substances (PFAS) and total fluorine in fire station dust. J Expo Sci Environ Epidemiol. February 2021. 

2021-2022

Free Research Studies 

1. Daniels RD, Kubale TL, Yiin JH, Dahm MM, Hales TR, Baris D, Zahm SH, Beaumont JJ, Waters KM, Pinkerton LE. Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009). Occup Environ Med. 2014 Jun.
2. Pukkala E, Martinsen JI, Weiderpass E, Kjaerheim K, Lynge E, Tryggvadottir L, Sparén P, Demers PA. Cancer incidence among firefighters: 45 years of follow-up in five Nordic countries. Occup Environ Med. 2014 Jun.
3. Jalilian H, Ziaei M, Weiderpass E, Rueegg CS, Khosravi Y, Kjaerheim K. Cancer incidence and mortality among firefighters. Int J Cancer. 2019 Nov.
4. Fent KW, Alexander B, Roberts J, Robertson S, Toennis C, Sammons D, Bertke S, Kerber S, Smith D, Horn G. Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures. J Occup Environ Hyg. 2017 Oct.
5. Dahm MM, Bertke S, Allee S, Daniels RD. Creation of a retrospective job-exposure matrix using surrogate measures of exposure for a cohort of US career firefighters from San Francisco, Chicago and Philadelphia. Occup Environ Med. 2015 Sep.
6. Booze TF, Reinhardt TE, Quiring SJ, Ottmar RD. A screening-level assessment of the health risks of chronic smoke exposure for wildland firefighters. J Occup Environ Hyg. 2004 May.

 Recommended Studies (Pay for) 

1. LeMasters GK, Genaidy AM, Succop P, Deddens J, Sobeih T, Barriera-Viruet H, Dunning K, Lockey J. Cancer risk among firefighters: a review and meta-analysis of 32 studies. J Occup Environ Med. 2006 Nov.
2. J Keir JLA, Akhtar US, Matschke DMJ, White PA, Kirkham TL, Chan HM, Blais JM. Polycyclic aromatic hydrocarbon (PAH) and metal contamination of air and surfaces exposed to combustion emissions during emergency fire suppression: Implications for firefighters’ exposures. Sci Total Environ. 2020 Jan
3. Keir JLA, Akhtar US, Matschke DMJ, Kirkham TL, Chan HM, Ayotte P, White PA, Blais JM. Elevated Exposures to Polycyclic Aromatic Hydrocarbons and Other Organic Mutagens in Ottawa Firefighters Participating in Emergency, On-Shift Fire Suppression. Environ Sci Technol. 2017 Nov.
   

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 Additional Resources