NFPA Journal - Fall 2023 - 37

VIEWPOINTS ON FIRE
AND LIFE SAFETY
a Group 1 carcinogen, meaning that it
causes cancer in humans.
The conclusion is hard to refute.
Cancer caused 66 percent of the career
firefighter line-of-duty deaths between
2002 and 2019, according to the
Firefighter Cancer Support Network,
a nonprofit group. That's more than
three times higher than heart disease
(the second-leading cause of line-ofduty
deaths, at 18 percent), and vastly
more than the deaths caused by fighting
fires.
According to the IARC, there is sufficient
scientific evidence that firefighting
causes mesothelioma and bladder
cancer, and more limited evidence for
five other types of cancers: colon, prostate,
testicular, melanoma of the skin,
and non-Hodgkin's lymphoma. Beyond
that, there are many questions as yet
unanswered. How many other forms
of cancer can be linked to firefighting?
What kinds of exposures are causing
such high rates of certain cancers? What
additional measures can be taken to
improve protection for firefighters?
This spring, the National Institute
for Occupational Safety and Health
(NIOSH) launched an ambitious,
decades-long project that goes farther
than any previous study in trying
to find those answers. As part of its
National Firefighter Registry for Cancer
(NFR), the agency hopes to enlist at
least 200,000 firefighters to share their
work and exposure histories on the job.
Over time, as some of the firefighters
in the study are diagnosed with cancer,
researchers will be able to analyze the
data to search for macro-level correlations
between exposures, prevention
strategies, and various types of cancers.
The scientists behind the study
believe that the results could dramatically
improve our understanding of
how job exposures increase cancer
risks in firefighters, and what fire
departments, code makers, equipment
manufacturers, and others can do to
reduce those risks. That knowledge
could have profound effects on myriad
NFPA fire service-related standards,
including those for personal protective
Even if firefighters are doing everything they can, such as wearing
very good personal protective equipment and keeping their SCBAs
on, we're still finding biological uptake of some carcinogens.
equipment, tactics, fire department
health programs, and more.
Dr. Kenny Fent, an industrial hygienist
who has spent 15 years researching
ways to lessen and control firefighters'
exposure to carcinogens, is the team
lead at NIOSH overseeing the cancer
registry. In April, after four years laying
the groundwork, Fent and his team
officially launched the NFR online
portal (nfr.cdc.gov), allowing firefighters
across the U.S. to sign up and share
their career histories.
NFPA Journal spoke with Fent to
learn more about the NFR, how it will
work, and how it may eventually lead
to reforms that keep future generations
of firefighters healthier and cancer free.
Is there any doubt now that
on-the-job exposures cause
cancer in firefighters?
There's no longer a doubt. IARC is the
world's governing body when it comes to
identifying carcinogens. I would say that
the evaluation last summer, which I was
proud to be a part of, showed clearly
that firefighting does increase the risk of
at least certain types of cancers.
Do we know at this point how
carcinogens get into firefighters?
I assume breathing smoke is one,
but are there others?
The full report from the IARC evaluation
[available at iarc.who.int] will be
coming out very soon. That will be the
best resource to understand all the scientific
evidence, including the biological
mechanisms for uptake. But the bottom
line is that we know-and I've shown
this over and over again in the research
I've done-that firefighters are exposed
to known carcinogens. We also know
that, at the present time, we don't have
very good methods of reducing those
exposures. Even if firefighters are doing
everything they can, such as wearing very
good personal protective equipment and
keeping their SCBAs on, we're still finding
biological uptake of some carcinogens
like benzene and polycyclic aromatic
hydrocarbons. Once those compounds
enter the body, they can start to impact
human biology and can lead to epigenetic
changes that that might ultimately
lead to cancer outcomes.
There have been many previous
studies on firefighting and cancer.
How is the National Firefighter
Registry for Cancer project different,
and why is it necessary?
To date, there have been a lot of great
studies done on cancer in the fire
service, but there are limitations with
those. For one, most of the previous
studies were conducted primarily
on white male firefighters from large
municipal departments. Since the studies
didn't include large numbers of
women, minorities, or volunteer firefighters,
or even career firefighters
across the nation, we don't fully understand
the cancer risk among those
specific groups. Secondly, most of these
studies were done decades ago, so we
don't really know what the cancer risk
looks like today among firefighters. All
of that was the motivation for Congress
to pass the Firefighter Cancer Registry
Act of 2018, which led directly to the
creation of the National Firefighter
Registry for Cancer.
What's your objective?
Everyone agrees that firefighting
increases the risks of cancer, but there
are still a lot of unknowns. For instance,
IARC found strong evidence for only
two types of cancers out of the 30 to 40
primary cancers we commonly study.
So, our objective is to create a voluntary
registry of thousands of firefighters that
reflects our nation's diverse fire service
and capture some basic information
NFPA .ORG/JOURNAL * NFPA JOURNAL | 37
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NFPA Journal - Fall 2023

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