Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950–2009)

Abstract

Objectives To examine mortality patterns and cancer incidence in a pooled cohort of 29 993 US career firefighters employed since 1950 and followed through 2009. Methods Mortality and cancer incidence were evaluated by life table methods with the US population referent. Standardised mortality (SMR) and incidence (SIR) ratios were determined for 92 causes of death and 41 cancer incidence groupings. Analyses focused on 15 outcomes of a priori interest. Sensitivity analyses were conducted to examine the potential for significant bias. Results Person-years at risk totalled 858 938 and 403 152 for mortality and incidence analyses, respectively. All-cause mortality was at expectation (SMR=0.99, 95% CI 0.97 to 1.01, n=12 028). There was excess cancer mortality (SMR=1.14, 95% CI 1.10 to 1.18, n=3285) and incidence (SIR=1.09, 95% CI 1.06 to 1.12, n=4461) comprised mainly of digestive (SMR=1.26, 95% CI 1.18 to 1.34, n=928; SIR=1.17, 95% CI 1.10 to 1.25, n=930) and respiratory (SMR=1.10, 95% CI 1.04 to 1.17, n=1096; SIR=1.16, 95% CI 1.08 to 1.24, n=813) cancers. Consistent with previous reports, modest elevations were observed in several solid cancers; however, evidence of excess lymphatic or haematopoietic cancers was lacking. This study is the first to report excess malignant mesothelioma (SMR=2.00, 95% CI 1.03 to 3.49, n=12; SIR=2.29, 95% CI 1.60 to 3.19, n=35) among US firefighters. Results appeared robust under differing assumptions and analytic techniques. Conclusions Our results provide evidence of a relation between firefighting and cancer. The new finding of excess malignant mesothelioma is noteworthy, given that asbestos exposure is a known hazard of firefighting.

Understanding the Economic Benefit Associated with Research and Services at the National Institute for Occupational Safety and Health: An Approach and Three Case Studies

“…Although the Daniels, Kubale, et al, 2014 study was one of the largest and most-definitive studies of cancer risk among firefighters, several previous studies explored these issues, as did other concurrent large studies in Australia Glass, Del Monaco, et al, 2017), Nordic countries (Pukkala et al, 2014), France (Amadeo et al, 2015), and Korea (Ahn, Jeong, and Kim, 2012;Ahn and Jeong, 2015). However, in interviews, industry leaders described the NIOSH publications of Daniels, Kubale, et al, 2014, andFent, Eisenberg, Evans, et al, 2013 as a turning point in efforts to prevent cancer in firefighters. Because the NIOSH study (Daniels, Kubale, et al, 2014) had a large sample and was based in the United States, fire chiefs, firefighters, and policymakers considered it more credible than any of the previous U.S. studies or studies in other countries, where safety standards, construction materials, and other environmental factors can be very different.…”

“…However, in interviews, industry leaders described the NIOSH publications of Daniels, Kubale, et al, 2014, andFent, Eisenberg, Evans, et al, 2013 as a turning point in efforts to prevent cancer in firefighters. Because the NIOSH study (Daniels, Kubale, et al, 2014) had a large sample and was based in the United States, fire chiefs, firefighters, and policymakers considered it more credible than any of the previous U.S. studies or studies in other countries, where safety standards, construction materials, and other environmental factors can be very different. In addition, NIOSH's experimental studies highlighted exposure pathways that could increase firefighters' risk of cancer, as well as steps that could be implemented to reduce this risk (e.g., Fent, Evans, and Couch, 2010;Fent, Eisenberg, Evans, et al, 2013;Fent, Eisenberg, Snawder, et al, 2014;Fent, Evans, Booher, et al, 2015;Fent, Alexander, et al, 2017).…”

“…Because the Daniels, Kubale, et al, 2014, andDaniels, Bertke, et al, 2015 studies measure cancer incidence for firefighters employed as early as the 1950s, much of the excess carcinogen exposure measured in the studies might have already been reduced before the early 2000s as control measures improved through time. To the extent that this is true, our estimates of the benefits of NIOSH efforts in this area overestimate the actual benefit because we attribute all reduction in risk to the new guidelines.…”

“…The Daniels, Kubale, et al, 2014, andDaniels, Bertke, et al, 2015 studies specifically looked at cancer incidence among career firefighters, so these estimates might not apply to firefighters with different occupational roles (e.g., paid on call, paid per call, volunteer) because their risks can be very different. Information from the IAFF indicates that more than 85 percent of the places where people live in the United States are served by career firefighters.…”

“…The first results from the study were published online (ahead of print) in 2013 (Daniels, Kubale, et al, 2014). The paper reported no increase in all-cause mortality but did find excess 30 See LeMasters et al, 2006, for a review of many of these studies.…”