With hundreds of pages of information available -  we will be highlighting, passing on and posting information focusing on Firefighter Cancer Facts - and how it is impacting departments volunteer and paid.

We want to live long, healthy lives after we retire

By Larissa Conroy

We all believe that our bunker gear is keeping out the big “C” word (cancer). What if I told you that the same bunker gear you’re wearing contains chemicals that are linked to cancer? How bad do you want to go out and put your gear on now? The National Fire Protection Association (NFPA) has minimum requirements for what your bunker gear should do. NFPA 1971, Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, states that your gear must have an outer shell, thermal liner, and moisture barrier. It also states you must have a means of securing the liner to the shell that must be inherently flame resistant, coats are required to have wristlets, a drag rescue device (DRD) must be accessible from the exterior with a gloved hand, and you much have a Thermal Protective Performance (TPP) minimum of 35 and a Total Heat Loss (THL) minimum of 205. However, it does not go into detail on what your bunker gear should be made of. That part is up to the manufacturers.

Let’s begin with the basics. The NFPA requires your gear to have a TPP minimum of 35, maximum of 50. The NFPA also requires your bunker gear to have a THL minimum of 205, no maximum. Your TPP is going to protect you from the outside heat, where the THL is going to protect you from your own inside heat. TPP (divided in half) measures the time a firefighter has to escape from flashover conditions. For example, if you have a TPP of 50, you would theoretically have 25 seconds to escape flashover conditions. THL measures the ability of the garment to let heat escape. You cannot max out both numbers. The best way to configure your bunker gear is to have a happy medium of both.

Dr. Graham Peaslee, professor of physics at the University of Notre Dame, has tested various types of bunker gear. His research is highlighting the amount of Polyfluoroalkyl Substances (PFAS) in our turnout gear. Two common types of PFAS that you may have heard of include Perfluorohexane Sulfonic Acid (PFHxS) and Perfluorooctane Sulfonate (PFOS) found in Aqueous Film Forming Foams (AFFF). PFAS is a class of man-made chemicals found in flame-resistant and water-resistant items, including AFFF and turnout gear. Conveniently enough, your bunker gear is flame resistant and water resistant. When PFAS chemicals break down, some of them can create PFOA and PFOS. These particular PFAS have been linked to thyroid disease, hypertension, immunosuppression, kidney cancer, and testicular cancer (2020, ATSDR). PFAS as a class are known as the “forever chemicals.” Once they get into the environment, they build up and never leave. They can also accumulate in your body, and although they will eventually leave, it will typically take months to years to do so. It’s so bad that, in fact, the Environmental Protection Agency (EPA) has a lifetime health advisory on the levels of PFOA and PFOS in our drinking water. European firefighters have known about the issue of PFOA in bunker gear and have set a 0.1 microgram/dm² limit on textiles in general. By July 2020, Europeans will have phased PFAS-containing foam out completely. The U.S. military is required to replace this foam from their trucks by 2022 and treats it as a hazardous material (2018, Station Pride).

In May 2017, the International Association of Fire Fighters (IAFF) released a statement claiming that there was no need to be concerned about PFOA in bunker gear because it had been phased out of bunker gear manufacturing since 2013 (2017, IAFF). No studies were released along with the IAFF’s statement. However, Dr. Peaslee’s findings were released in February 2018. Many “experts” and bunker gear manufacturers have refuted the claims and even called them false claims, saying that there has been no use of PFOA in turnout gear. There are some sources that say it’s the fireground, not the turnout gear. Despite the many articles saying there are no toxic chemicals on our bunker gear, there are no facts or research supporting those claims. The only published proof is Dr. Peaslee’s work, showing the presence of these chemicals on bunker gear. Diane Cotter, wife of a former Massachusetts firefighter, had spearheaded the campaign for more research and testing of our bunker gear. Push for more research came after her husband was diagnosed with prostate cancer. Today her husband lives cancer free, but Mrs. Cotter presses on for the testing of PFOA in bunker gear. 

Many attempts at reaching out to manufacturers themselves have not proved to be fruitful. No bunker gear manufacturing company wants to release the chemical composition of its bunker gear. Bunker gear manufacturers aware of the harmful PFOA claim they have switched to newer “safer” chemical compounds; however, the newer/safer compounds are still a form of PFAS. Some of these chemicals come from other PFAS in the gear that turn into PFOA with exposure and wear. Still others release certain PFAS for which the toxicity in humans is unknown.

How do we go about fixing this? Well, first it is important to say that in a fire situation it is important to wear your PPE. It keeps you safe in a fire. However, I have a few ideas of things you can do and some things you shouldn’t do that will keep your safer in your gear:

1. Don’t work out in your bunker gear. Working out causes your pores to open up and accept the unnecessary risk of letting these chemicals into your body. While preparing yourself for the intensity of what you may come across during a fire, I see no reason why anyone should put on bunker gear for physical fitness–especially not until we have all the facts about what exactly is put into and/or on our bunker gear. You are putting yourself at an unnecessary risk of exposure to PFAS by doing so. 
2. Clean Cabs.  There are departments working toward the initiative of cleaner cabs. This is important. Keeping your bunker gear in the cab of your truck, you are unnecessarily exposing yourself to not only the harmful chemicals on your gear but carcinogens from previous fires. We need to strongly consider the risk vs. reward aspect of keeping your bunker gear in the truck under the small chance that you might get a fire.
3. Don’t allow children to touch your bunker gear. If your station does frequent tours and children walk through the truck or touch your gear, you are exposing children to these harmful chemicals as well as anything else that may be on your bunker gear. If you cook dinner for your crew, groceries may come in contact with the back of the truck, another unnecessary exposure. These exposures are affecting not just you but other people around you.
4. Don’t take newborn/marriage/family photos with your gear. New parents sometimes like to have professional pictures done with their babies in or on their bunker gear. This is now something that seems more horrifying to me than cute. 
5. Handle your bunker gear with gloves whenever possible. You respect the fires and what carcinogens you may come in contact with when you fight fire. Why not treat your gear with the same respect and glove up before taking it apart, putting it together, or handling it for inspection?

I could go on about the risk of PFAS in our bunker gear and class B foams. Diane Cotter and Dr. Peaslee have done extensive research and are continuing to push nationally for the research and funding required to test bunker gear. As firefighters, we are required to take measures to protect ourselves from cancer. New cancer legislation requires current firefighters to be nonsmokers. Fire academies are requiring new students to be tobacco-free for one to two years prior to enrollment in fire school. We, as firefighters, understand the risks we are taking when we sign up for the job. We are taking measures to prevent cancer because we want to live long, healthy lives after we retire. Shouldn’t we require the manufacturers to provide us with a list of chemicals that goes into the manufacturing of our bunker gear? This way, we can make a smarter, more informed decision about what gear we are choosing. We don’t need bunker gear that withstands hotter temperatures; we need smarter firefighters! Humans haven’t evolved to the point of survival that if they are trapped in a fire, we will be able to save them by having bunker gear that withstands hotter temperatures. 

Sources:

May 2017 (IAFF) PFOA and Turnout Gear

February 18, 2018 (Cotter, D.) Fire Gear Laboratory Test Results

January 21, 2020 (Agency For Toxic Substances and Disease Registry) Per- and Polyfluoroalkyl Substances (PFAS) and Your Health
 

Larissa Conroy is a firefighter/paramedic for the Orlando (FL) Fire Department. She has an A.S. degree in emergency medical services; Fire Officer 1 certification; and several specialty certificates including Hazmat Technician, VMR Technician, Confined Space Technician, and many others. 

Copyright © 2019 - 2020

All information below may be found at this link https://firefightercancersupport.org/     -  © 2020 FIREFIGHTER CANCER SUPPORT NETWORK

The International Association of Fire Fighters online cancer awareness and prevention course, created in cooperation with FCSN, launched in May 2016.

FCSN instructors deliver our award-winning cancer-prevention training every day. Our popular train-the-trainer program gives instructors the cancer-fighting tools and curriculum they can take back to their departments. We now have FCSN-trained instructors in nearly every state, across Canada, and all the way to Ireland and Australia. FCSN also provides training at some of the largest fire-service events, including the Fire Department Instructors Conference, at the National Fire Academy, and at a number of state fire training academies.

Making an Impact

We also provide training for fire departments large and small. In 2015, FCSN collaborated with Boston Fire Commissioner Joseph Finn and leaders of IAFF Local 718 to bring our cancer-prevention training to Boston. Cancer caused 67 percent of the Boston Fire Department’s line-of-duty deaths between 2002-2014.

“Boston firefighters develop cancer at a rate two-and-a-half times higher than other Boston residents,” Finn said. “We have recognized cancer’s effect on our firefighters, and FCSN’s department-wide prevention training is an important part of our ongoing, comprehensive safety, health, and wellness program.”

IAFF Local 718 President Richard Paris agreed. “Since 1990, the Boston Fire Department has lost 190 members to cancer,” Paris said. “It’s a staggering number. We know that cancer is killing our members, and we’re making a collaborative effort to save the lives of Boston firefighters. FCSN’s training focuses on preventive measures the department and firefighters can take to reduce exposure to carcinogens and help avoid contracting this deadly disease.”

FCSN President Bryan Frieders, a deputy chief with the Pasadena (CA) Fire Department, praised Boston’s collaborative, aggressive approach to reducing firefighters’ occupational cancer risk. “Addressing the occupational cancer epidemic requires a cultural change for the fire service,” Frieders said. “Joe Finn and Richie Paris are leading from the front. Their work together with FCSN illustrates how effective labor-management relationships can be to enhance the safety and well-being of firefighters.”

Cancer is the most dangerous threat to firefighter health and safety today.

• Cancer caused 61 percent of the career firefighter line-of-duty deaths from January 1, 2002, to March 31, 2017, according to data from the International Association of Fire Fighters (IAFF). Heart disease caused 18 percent of career LODDs for the same period.
• Cancer caused 70 percent of the line-of-duty deaths for career firefighters in 2016.
• Firefighters have a 9 percent higher risk of being diagnosed with cancer and a 14 percent higher risk of dying from cancer than the general U.S. population, according to research by the CDC/National Institute for Occupational Health and Safety (NIOSH).

The cancers mostly responsible for this higher risk were respiratory (lung, mesothelioma), ?GI (oral cavity, esophageal, large intestine), and kidney.

Are firefighters’ risks for certain types of cancer significantly higher?

Firefighters’ risks are significantly higher for some specific types of cancer than the general population.

In 2013, NIOSH researchers reported a two-fold excess of malignant mesothelioma, a very rare cancer. Put another way, firefighters have a 100 percent increased risk (100 percent = double = 2 times) of getting mesothelioma. Firefighters have a 129 percent increased risk of dying from mesothelioma. A 2006 meta-analysis by Grace LeMasters of 32 firefighter cancer studies noted a two-fold excess for testicular cancer. Firefighters have a 62 percent higher risk of getting esophageal cancer, and they have a 39 percent increased risk of dying from esophageal cancer, according to the NIOSH research.

Here’s an overview with some specific additional risks for firefighters noted:

• testicular cancer – 2.02 times the risk (again: 100% = double = 2 times);
• mesothelioma – 2.0 times greater risk;
• multiple myeloma -1.53 times greater risk;
• non-Hodgkin’s lymphoma – 1.51 times greater risk;
• skin cancer – 1.39 times greater risk;
• malignant melanoma – 1.31 times ?greater risk;
• brain cancer -1.31 times greater risk;
• prostate cancer – 1.28 times greater risk;
• colon cancer -1.21 times great risk; and
• leukemia – 1.14 times greater risk.

What about cancer statistics for volunteer firefighters?

There’s little data about cancer among volunteer firefighters, but firefighting increases cancer risks significantly for all firefighters. The Firemen’s Association of the State of New York (FASNY) and Northwell Health launched a research project in 2017 to examine cancer incidence and mortality among NY volunteers. We will be sharing details about that research as they develop.

What about cancer statistics for women and non-white firefighters?

There have been relatively few studies about cancer among women and non-white firefighters, in part due to their statistically smaller representation in the fire service. There’s a small but growing number of studies with women firefighters and the specific cancer risks they face. We will be sharing details about that research as it develops. Black men have the highest risk of prostate cancer overall, according to CDC data from 2013, the most recent year for which data has been reported. The International Association of Black Professional Firefighters provides periodic prostate cancer prevention tips to its members via an email newsletter.

What research supports the link between firefighting and cancer?

Research spanning decades, continents, and more than 80,000 firefighters validates the connection between firefighting and occupational cancer. Here is an overview of key studies.

• The 2017 Blais University of Ottawa study examined chemical exposure occurring during emergency, on-shift fire suppression. The researchers found firefighters absorb harmful chemicals, including polycyclic aromatic hydrocarbons (PAHs), through their skin. Firefighters had from three to more than five times the amount of by-products of PAHs in their urine after a fire compared to before the fire.
• The 2013 Daniels NIOSH study (phase 1) is the largest study of U.S. firefighters to date. It examined mortality patterns and cancer incidence for 30,000 firefighters. The NIOSH study, which began in 2010, found statistically significant mortality and incidence rates of all cancers and cancers of the esophagus, intestine, lung, kidney, and oral cavity, as well as increased mesothelioma for firefighters compared with the general population. The NIOSH study found excess risk of bladder and prostate cancers at younger ages. The NIOSH study also is significant because it spanned geographical distance (San Francisco, Chicago, Philadelphia) and decades (1950-2009). It is one of the few studies to date that has included women and non-white firefighters.
• The 2015 Daniels NIOSH study (phase 2) examined firefighters’ work histories and variables such as fire runs, use of personal protective equipment (PPE), and use of diesel exhaust control systems. It compared the cancer risk for firefighters with higher exposures to carcinogens with those who had lower exposures. In this phase, researchers found that lung cancer and leukemia risk increased with exposure.
• The 2014 Pukkala Nordic study of 16,422 firefighters from five Nordic countries found an increased risk for all cancers combined among firefighters, similar to the NIOSH phase 1 study. It found significant increases in melanoma and non-melanoma skin cancer; lung cancer; and prostate cancer from 1961 to 2005.
• The 2008 Kang Massachusetts study compared cancer incidence among Massachusetts firefighters with that of Massachusetts police officers and other occupations. When compared with police officers, firefighters were found to have increased cancer risks. This study found the firefighters had a 90 percent higher risk for brain cancer and an 81 percent higher risk for Hodgkin’s lymphoma. Researchers examined data from 1987-2003.
• The 2006 LeMasters meta-analysis reviewed data from 32 studies of firefighters for 20 different types of cancer. Risks for 10 types of cancer were “significantly increased” in firefighters. Risks for the other 10 types were increased, although not to the same extent.
• The 2006 Fangchao Ma Florida study compared Florida firefighters’ cancer incidence rates (rather than mortality) with those of the general Florida population. It was the first such study to include women. Florida researchers examined data for 34,796 male and 2,017 female firefighters and found 1,032 total cases of cancer (970 male & 52 female). The top cancers for male firefighters were prostate (13.7 percent), skin (8.4 percent), colon (7.1 percent), bladder (6.9 percent), and testicular (5.5 percent). The most prominent cancers for female firefighters in Florida were breast (27.8 percent) skin (7.6 percent), thyroid (5.6 percent) and lung (4.6 percent).

Are erroneous firefighter cancer statistics a concern?

Accurate data is crucial when quantifying occupational cancer’s toll on—and threat to—firefighters and their families. Recently, a number of well-intended journalists, legislators, manufacturers, and others have cited inaccurate firefighter cancer statistics, including the following erroneous examples:

• “…the risk of cancer in firefighters is 250% greater than in people not in our line of work.”
• “In all, researchers found that more than two-thirds of firefighters–68 percent–develop cancer, compared to about 22 percent for the general population…”
• “Firefighters…have a 68% higher risk of being diagnosed with cancer than the general population.”
• “Research is showing 68% of firefighters will come down with cancer on average.”
• “…More than two-thirds of firefighters are diagnosed with with…cancer.”
• “…63% of all firefighters will get cancer.”
• “…[Researchers] found that firefighters are twice as likely to be diagnosed with cancer…”
• “…[F]irefighters are 50 percent more likely to be diagnosed with cancer than the…U.S. population.”
• “A firefighter has a 29% higher risk of contracting cancer than the rest of our population.”

The proliferation of inaccurate statistics concerns Robert D. Daniels, PhD, CHP. In 2010, Daniels led the largest cancer study of U.S. firefighters to date for the National Institute for Occupational Safety and Health (NIOSH). “Some sources cite our study as reporting a two-fold excess of cancer among firefighters, then go on to say that two-thirds of firefighters are diagnosed with cancer,” Daniels said. “Neither statement is correct.”

Note that some fire departments are addressing occupational-cancer rates that are higher than national averages. For example, FCSN instructors cite insurer statistics for Miami-Dade Fire Rescue: 32 percent (nearly one-third) of MDFR’s active members were diagnosed with cancer or receiving cancer treatment between 2008-2010.

© 2020 FIREFIGHTER CANCER SUPPORT NETWORK