Firefighters Are More Prone To Develop Cancer; Drs. Cite Exposure To Toxins Under Extreme Heat

By GINGER ADAMS OTIS

A new health analysis conducted by doctors at the University of Cincinnati found that on-the-job exposure to soot and toxins creates an increased risk for certain types of cancer among firefighters.

GRACE LeMASTERS: Avoid toxins on skin.

The analysis used data from 32 health studies conducted among firefighters over the past 50 years, and then quantitatively assessed the probable, possible and unlikely risk of 21 cancers among that work force.

Prime Risks

According to its results, firefighters are significantly more likely than the regular population to develop multiple myelomas, and are at elevated risk for non-Hodgkin's lymphoma, prostate and testicular cancers.

Firefighters face "possible" increased risk for many other types of cancers, including melanoma and other skin malignancies, cancer of the brain, rectum, stomach, oral pharynx and colon.

Dr. Grace LeMasters and Dr. James Lockey published their findings in this month's Journal of Occupational and Environmental Medicine.

The results weren't a shock, they said, since it was known that firefighters were routinely exposed to potentially cancer-causing agents. But they were surprised in some cases by the rates of increased risk for particular malignancies.

JAMES LOCKEY: Exposures add up.

Can't Keep Soot Out

"I think we have underappreciated the exposures that may occur through the skin. We know when there is a hot environment, the skin dilates, becoming more porous," said Dr. LeMasters. "I talked to many firefighters who said even though they were wearing all their protective clothing, they still were covered with soot at the end of a fire."

Dr. Lockey commented that an elevated rate of cancer occurrence among a group of extremely fit people is a medical anomaly, but "when you factor in the acute exposures that firefighters suffer long-term, over 25 to 30 years, it's not at all surprising."

The substances identified as the most potentially harmful to firefighters included particulates, gases, mists and fumes of an organic and/or inorganic nature.

They are also routinely exposed to heavy metals, carcinogenic chemicals, volatile gases, minerals like asbestos and other toxic matter, and building debris that can contain pulverized cement, glass, fiberglass, silica, soot and combustion products.

Deceptive Dangers

Many times firefighters are exposed to toxins at routine calls when they don't feel it necessary to wear their breathing masks or protective gear, Dr. LeMasters said.

"In some situations, [firefighters] suffer unrecognized exposure. At the firehouse where they spend long hours, exposures may occur to complex mixtures that comprise diesel exhaust, particularly if trucks are run in closed houses without adequate outside venting," she wrote.

The report analyzed the results of many different health studies performed among 110,000 mostly male firefighters in the U.S. and overseas over the past 50 years. In many cases, Dr. LeMasters cautioned, the results were from a time when firefighters didn't have the protective bunker gear they are equipped with today. She also suggested improvements be done to the gear to prevent smoke and soot from creeping in around cuffs, neck openings, and pant legs.

"There have been great strides in equipment and technology since some of these studies were done," she noted. "However, one of the recommendations we have is that firefighters, when returning to a station from a fire, immediately bathe with soap and water to cleanse their bodies of all residue."

Added Exposure

Given the stressful nature of the job, the doctors said, firefighters battling extended blazes often step out of the fire, remove some of their equipment while they rehydrate, and then head back in. That leaves multiple opportunities for skin and respiratory exposure in an atmosphere already conducive for transdermal absorption of toxins.

"We need a more detailed look at work practices, and some may have to be adjusted to allow for the early removal of substances on skin as soon as possible," commented Dr. Lockey.

They also said firefighters should immediately clean clothes and bunker gear worn in a fire or to any other type of emergency. They cautioned against donning smoky or sooty clothes, even for short periods.

Lieut. Stephen J. Carbone, vice president of the Uniformed Fire Officers' Association, said the Fire Department had implemented several initiatives designed to minimize the absorption of toxins through the skin.

Got Protective Bags

"We have some officers who go from firehouse to firehouse filling in vacancies, and they have to carry their gear with them," he commented. "One of the issues early on with the UFOA was getting the department to provide bags so the gear wouldn't contaminate other clothes, the back seats of cars, or other items. To its credit, the department did provide them."

The FDNY also issues two sets of bunker gear per firefighter, so that one can be worn while the other is being cleaned. The department maintains a rotating schedule to pick up dirty gear for an industrial decontamination.

Additionally, whenever there's an emergency where firefighters are believed to have suffered severe exposure, or there was a known lethal toxin on-site, the FDNY dispatches a special ops truck that retrieves firefighters' clothes, gear and then runs the members through a thorough decontamination process before letting them re-enter their firehouse.

Greater Danger Today

But there was still a need for "ongoing education" among members, said Mr. Carbone. "Responding to a fire in the '70s and even early '80s meant burning wood, linens, paper, pictures, things like that," he commented. "Now everything is plastic, or made of polyvinyl chlorates and other toxic substances when burning. I once had an instructor who told me that everything single item in a car when burning gives off a known carcinogen. And we respond to car fires all the time." Uniformed Firefighters' Association President Stephen J. Cassidy commended the study and said it had suggested a "unique approach" to a serious problem.

"The statistics are clear - firefighters suffer a dramatically higher cancer rate [than the general population]," he said. "Not only do we breathe in toxins while fighting fires; when we are in a super-heated atmosphere, sweating profusely, our skin can easily absorb soot and other materials.

'Common-Sense Idea'

He said Dr. LeMasters's recommendation that the FDNY mandate showers and clean clothes for firefighters after every fire was a "common-sense" suggestion.

"I hope the FDNY does require firefighters after a fire to go back and shower to remove whatever might be on their skin, even though culturally, some firefighters might resist going unavailable for half an hour - they hate to miss fires," commented Mr. Cassidy. "But I think the department should mandate that, and in the future I'm sure it will be done. It's in everyone's best long-term interests to reduce our risk of cancer and protect firefighter health."

The University of Cincinnati study was commissioned by the Ohio State Workers' Compensation Board, which was looking for information on the prevalence of cancers among firefighters to better assess compensation claims filed by its Fire Department members.

'Risk Depends on Heat'

Dr. Lockey said the volatile nature of the job made it difficult to pinpoint with certainty which types of exposures could, over time, lead to an increased cancer risk.

"A lot depends on the heat to which one is exposed. A plastic substance that burns at one temperature results in one type of exposure, and at a higher temperature it results in a different exposure," said Dr. Lockey.

The bottom line, the doctors stressed, is that while cancer is a rare outcome among firefighters, enough evidence of increased risk exists to warrant extreme caution even at job sites that don't appear hazardous.