The Fire Fighter Cancer Cohort Study: Protocol for a Longitudinal Occupational Cohort Study of United States Firefighters (Preprint)

Abstract

BACKGROUND Firefighters are at increased risk of cancer and other health conditions compared with the general population. However, the specific exposures and mechanisms contributing to these risks are not fully understood. This information is critical to formulate and test protective interventions. OBJECTIVE The purpose of the Fire Fighter Cancer Cohort Study (FFCCS) is to conduct community-engaged research with the fire service to advance evaluation and reduction of firefighter exposures, along with understanding and mitigating effects leading to an increased risk of cancer and other health conditions. This involves establishing a long-term (30+ year) firefighter multicenter prospective cohort study. METHODS The structure of the FFCCS includes a fire service oversight and planning board (OPB) to provide guidance and foster communication between researchers and fire organizations; a data coordinating center (DCC) overseeing survey data collection and data management; an exposure assessment center (EAC) working with quantitative exposure data to construct a firefighter job exposure matrix; and a biomarker analysis center (BAC), including a biorepository. Together the centers evaluate the association between firefighter exposures and toxic health effects. Firefighter research liaisons are involved in all phases of the research. The FFCCS research design primarily utilizes a set of core and project-specific survey questions accompanied by collection of biological samples (blood and urine) for analysis of biomarkers of exposure and effect. Data and samples are collected upon entry into the study, with subsequent collection after eligible exposures, and at intervals (e.g. 1-2 years) after enrollment. FFCCS data collection and analysis have been developed to evaluate unique exposures for specific firefighter groups, cancer risks, and endpoints in addition to cancer, such as reproductive outcomes. Recruitment is carried out with coordination from partnering fire departments and eligible participants, including active career and volunteer firefighters in the United States (US). RESULTS FFCCS study protocol development was first funded by the US Federal Emergency Management Agency (FEMA) in 2016, with enrollment beginning in February of 2018. As of September 2024, >6,200 participants from >275 departments across 31 states have enrolled, including recruit and incumbent firefighters. Biological samples have been analyzed for measures of exposure and effect. Specific groups enrolled in the FFCCS include career and volunteer structural firefighters, women firefighters, trainers, fire investigators, wildland firefighters, firefighters responding to wildland-urban interface (WUI) fires, and airport firefighters. Peer-reviewed published results include measurement of exposures and the toxic effects of firefighting exposure. Whenever possible, research results are provided back to individual participants. CONCLUSIONS The FFCCS is a unique fire service community-engaged multicenter prospective cohort study. Study results are contributing to evaluation of exposures, effects, and preventive interventions across multiple sectors of the US fire service with broad implications nationally.