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Cited by 334Occupational Health and PerformanceGlobal Cancer Incidence and ScreeningFire dynamics and safety research

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

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Daniels, Robert D, Kubale, Travis L, Yiin, James H, Dahm, Matthew M, Hales, Thomas R, Baris, Dalsu, Zahm, Shelia H, Beaumont, James J +2 more·2014·Occupational and Environmental Medicine
DOI 10.1136/oemed-2013-101662PMC PMC4499779
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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.

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  • In 2015, an estimated 30,000 firefighters were mobilized to contend with wildland fires.

    “In 2015, an estimated 30 000 firefighters were mobilized to contend with wildland fires. 71”

    From The costs and losses of wildfires: a literature survey (2017) · cites this paper as [71]

    The Results (page not available) report 29,993 firefighters in a study cohort, not firefighters mobilized for wildland fires. Searches for 2015 mobilization and wildland firefighting found no passage addressing the claim. (LLM, conf=0.78)

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Research works printed but not linked: 39

  1. [2]International Agency for Research on Cancer IARC working group on the evaluation of carcinogenic risks to humans. Painting, firefighting, and shiftwork IARC Monogr Eval Carcinog Risks Hum 2010 98 9 764 21381544 PMC4781497
  2. [3]Aronson KJ Tomlinson GA Smith L Mortality among fire fighters in metropolitan Toronto Am J Ind Med 1994 26 89 101 8074127
  3. [4]Tornling G Gustavsson P Hogstedt C Mortality and cancer incidence in Stockholm fire fighters Am J Ind Med 1994 25 219 28 8147394
  4. [5]Vena JE Fiedler RC Mortality of a municipal-worker cohort: IV. Fire fighters Am J Ind Med 1987 11 671 84 3605104
  5. [6]Demers PA Heyer NJ Rosenstock L Mortality among firefighters from three northwestern United States cities Br J Ind Med 1992 49 664 70 1390274 PMC1039313
  6. [7]Bates MN Registry-based case-control study of cancer in California firefighters Am J Ind Med 2007 50 339 44 17427202
  7. [8]Kang D Davis LK Hunt P Cancer incidence among male Massachusetts firefighters, 1987–2003 Am J Ind Med 2008 51 329 35 18306327
  8. [9]Baris D Garrity TJ Telles JL Cohort mortality study of Philadelphia firefighters Am J Ind Med 2001 39 463 76 11333408
  9. [10]Beaumont JJ Chu GS Jones JR An epidemiologic study of cancer and other causes of mortality in San Francisco firefighters Am J Ind Med 1991 19 357 72 2008922
  10. [11]Ma F Fleming LE Lee DJ Cancer incidence in Florida professional firefighters, 1981 to 1999 J Occup Environ Med 2006 48 883 8 16966954
  11. [12]Ma F Fleming LE Lee DJ Mortality in Florida professional firefighters, 1972 to 1999 Am J Ind Med 2005 47 509 17 15898094
  12. [13]Heyer N Weiss NS Demers P Cohort mortality study of Seattle fire fighters: 1945–1983 Am J Ind Med 1990 17 493 504 2327416
  13. [14]LeMasters GK Genaidy AM Succop P Cancer risk among firefighters: A review and meta-analysis of 32 studies J Occup Environ Med 2006 48 1189 202 17099456
  14. [16]Schubauer-Berigan MK Hein MJ Raudabaugh WM Update of the NIOSH life table analysis system: a person-years analysis program for the windows computing environment Am J Ind Med 2011 54 915 24 22068723
  15. [17]Robinson CF Schnorr TM Cassinelli RT II Tenth revision U.S. mortality rates for use with the NIOSH Life Table Analysis System J Occup Environ Med 2006 48 662 7 16832222
  16. [19]Merrill RM Sloan A Novilla LB Understanding population-based site-specific cancer incidence rates in the USA J Cancer Educ 2012 27 263 8 21874603
  17. [20]Applebaum KM Malloy EJ Eisen EA Reducing healthy worker survivor bias by restricting date of hire in a cohort study of Vermont granite workers Occup Environ Med 2007 64 681 7 17449560 PMC2078404
  18. [21]Sorahan T Bladder cancer risks in workers manufacturing chemicals for the rubber industry Occup Med (Lond) 2008 58 496 501 18725381
  19. [22]Schottenfeld D Fraumeni JF Cancer epidemiology and prevention 2006 Oxford University Press Oxford; New York, NY 3rd
  20. [24]Markowitz SB Garibaldi K Lilis R Asbestos and fire fighting Ann N Y Acad Sci 1991 643 573 81 1809170
  21. [25]Benbrahim-Tallaa L Baan RA Grosse Y Carcinogenicity of diesel-engine and gasoline-engine exhausts and some nitroarenes Lancet Oncol 2012 13 663 4 22946126
  22. [26]International Agency for Research on Cancer IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, Arsenic, metals, fibres, and dusts. Volume 100C. A review of human carcinogens IARC Monogr Eval Carcinog Risks Hum 2012 100 11 465 23189751 PMC4781271
  23. [27]International Agency for Research on Cancer IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Personal habits and indoor combustions. Volume 100 E. A review of human carcinogens IARC Monogr Eval Carcinog Risks Hum 2012 100 1 538 PMC4781577 23193840
  24. [28]Paget-Bailly S Cyr D Luce D Occupational exposures to asbestos, polycyclic aromatic hydrocarbons and solvents, and cancers of the oral cavity and pharynx: a quantitative literature review Int Arch Occup Environ Health 2012 85 341 51 21785866
  25. [29]Paget-Bailly S Cyr D Luce D Occupational exposures and cancer of the larynx-systematic review and meta-analysis J Occup Environ Med 2012 54 71 84 22157731
  26. [30]Haddock CK Jitnarin N Poston WS Tobacco use among firefighters in the central United States Am J Ind Med 2011 54 697 706 21656838 PMC5858201
  27. [31]Lee DJ LeBlanc W Fleming LE Trends in US smoking rates in occupational groups: the National Health Interview Survey 1987–1994 J Occup Environ Med 2004 46 538 48 15213515
  28. [32]Poston WS Haddock CK Jitnarin N A national qualitative study of tobacco use among career firefighters and department health personnel Nicotine Tob Res 2012 14 734 41 22180587 PMC6281053
  29. [33]Lee DJ Fleming LE Arheart KL Smoking rate trends in U.S. occupational groups: the 1987 to 2004 National Health Interview Survey J Occup Environ Med 2007 49 75 81 17215716
  30. [34]Munir F Clemes S Houdmont J Overweight and obesity in UK firefighters Occup Med (Lond) 2012 62 362 5 22679213
  31. [35]Poston WS Jitnarin N Haddock CK Obesity and injury-related absenteeism in a population-based firefighter cohort Obesity (Silver Spring) 2011 19 2076 81 21633400 PMC5831189
  32. [36]Tsismenakis AJ Christophi CA Burress JW The obesity epidemic and future emergency responders Obesity (Silver Spring) 2009 17 1648 50 19300435
  33. [40]Boxer PA Wild D Psychological distress and alcohol use among fire fighters Scand J Work Environ Health 1993 19 121 5 8316779
  34. [41]Leiss JK Ratcliffe JM Lyden JT Blood exposure among paramedics: incidence rates from the national study to prevent blood exposure in paramedics Ann Epidemiol 2006 16 720 5 16581265
  35. [42]Rischitelli G Harris J McCauley L The risk of acquiring hepatitis B or C among public safety workers: a systematic review Am J Prev Med 2001 20 299 306 11331121
  36. [43]Boal WL Hales T Ross CS Blood-borne pathogens among firefighters and emergency medical technicians Prehosp Emerg Care 2005 9 236 47 16036853
  37. [44]Potosky AL Miller BA Albertsen PC The role of increasing detection in the rising incidence of prostate-cancer JAMA 1995 273 548 52 7530782
  38. [45]Moyer VA Screening for bladder cancer: U.S. Preventive Services Task Force recommendation statement Ann Intern Med 2011 155 246 51 21844550
  39. [46]Demers PA Checkoway H Vaughan TL Cancer incidence among firefighters in Seattle and Tacoma, Washington (United States) Cancer Causes Control 1994 5 129 35 8167259

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Authors
Daniels, R. D., Kubale, T. L., Yiin, J. H., Dahm, M. M., Hales, T. R., Baris, D., Zahm, S. H., Beaumont, J. J., Waters, K. M., & Pinkerton, L. E.
Affiliations
  • National Institute for Occupational Safety and Health (US)
  • National Cancer Institute (US)
  • University of California, Davis (US)
Corresponding author
Daniels, Robert D
ORCID
Venue
Occupational and Environmental Medicine
Publisher
BMJ
Published
2013-10-14
Volume
71
Issue
6
Pages
388-397
ISSN
  • 0007-1072 (ISSN-L)
  • 1351-0711
  • 1470-7926
DOI
10.1136/oemed-2013-101662
PMC
PMC4499779
OpenAlex
W2095763082
Cited by
334
References
2
Citations by year
2026: 15 · 2025: 18 · 2024: 20 · 2023: 44 · 2022: 30 · 2021: 42 · 2020: 48 · 2019: 27 · 2018: 19 · 2017: 24 · 2016: 18 · 2015: 20 · 2014: 7 · 2013: 2
FWCI
49.23
Type
journal article
Language
en
Open access
Locations
  • Occupational and Environmental Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Institutes of Health (n01pc35139-25-0-11, CC999999, n01pc35136-24-0-2)
  • National Cancer Institute (N01 PC035139, N01 PC035136, N02 PC015105)
  • National Institute for Occupational Safety and Health
Topics
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Physical Sciences › Engineering › Safety, Risk, Reliability and Quality › Fire dynamics and safety research
Keywords
firefighters, occupational cancer, cancer mortality, malignant mesothelioma, gastrointestinal cancer, respiratory cancer, solid tumors, occupational exposure, pooled cohort, San Francisco, Chicago, Philadelphia, excess mortality, standardized mortality ratio, standardized incidence ratio, life tables, cause-specific mortality, firefighter health
MeSH terms
Mesothelioma, Malignant, Adult, Aged, Asbestos, Cause of Death, Chicago, Digestive System Neoplasms, Female, Humans, Lung Neoplasms, Male, Mesothelioma, Middle Aged, Neoplasms, Occupational Diseases, Respiratory Tract Neoplasms, San Francisco, Philadelphia, Cohort Studies, Incidence, Occupational Exposure, Firefighters

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