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Cited by 141Occupational Health and PerformanceGlobal Cancer Incidence and ScreeningFire dynamics and safety research

Exposure–Response Relationships for Select Cancer and Non- Cancer Health Outcomes in a Cohort of US Firefighters from San Francisco, Chicago and Philadelphia (1950–2009)

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Daniels, Robert D, Bertke, Stephen, Dahm, Matthew M, Yiin, James H, Kubale, Travis L, Hales, Thomas R, Baris, Dalsu, Zahm, Shelia H +3 more·2015·Occupational and Environmental Medicine
DOI 10.1136/oemed-2014-102671PMC PMC4558385
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Abstract

OBJECTIVES: To examine exposure-response relationships between surrogates of firefighting exposure and select outcomes among previously studied US career firefighters. METHODS: Eight cancer and four non-cancer outcomes were examined using conditional logistic regression. Incidence density sampling was used to match each case to 200 controls on attained age. Days accrued in firefighting assignments (exposed-days), run totals (fire-runs) and run times (fire-hours) were used as exposure surrogates. HRs comparing 75th and 25th centiles of lagged cumulative exposures were calculated using loglinear, linear, log-quadratic, power and restricted cubic spline general relative risk models. Piecewise constant models were used to examine risk differences by time since exposure, age at exposure and calendar period. RESULTS: Among 19,309 male firefighters eligible for the study, there were 1333 cancer deaths and 2609 cancer incidence cases. Significant positive associations between fire-hours and lung cancer mortality and incidence were evident. A similar relation between leukaemia mortality and fire-runs was also found. The lung cancer associations were nearly linear in cumulative exposure, while the association with leukaemia mortality was attenuated at higher exposure levels and greater for recent exposures. Significant negative associations were evident for the exposure surrogates and colorectal and prostate cancers, suggesting a healthy worker survivor effect possibly enhanced by medical screening. CONCLUSIONS: Lung cancer and leukaemia mortality risks were modestly increasing with firefighter exposures. These findings add to evidence of a causal association between firefighting and cancer. Nevertheless, small effects merit cautious interpretation. We plan to continue to follow the occurrence of disease and injury in this cohort.

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  • Occupational exposure to PFAS in AFFF may present health risks to firefighters.

    “Occupational exposure to PFAS in AFFF may also present health risks to firefighters [5,6,7].”

    From In-Vitro and In-Silico Assessment of Per- and Polyfluoroalkyl Substances (PFAS) in Aqueous Film-Forming Foam (AFFF) Binding to Human Serum Albumin (2021) · cites this paper as [5]

    The Introduction says firefighters may encounter carcinogens, and the Conclusions report modestly increasing lung-cancer and leukaemia mortality risks with firefighter exposure. The paper does not identify PFAS or AFFF as an exposure or link either to those risks; searches for PFAS, AFFF, and firefighting foam found no such passage. (LLM, conf=0.86)

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  1. [27]Rothman KJ Greenland S Lash TL Modern epidemiology Philadelphia, PA Wolters Kluwer Health/Lippincott Williams & Wilkins 2008
  2. [28]Langholz B Thomas D Xiang A Latency analysis in epidemiologic studies of occupational exposures: application to the Colorado Plateau uranium miners cohort Am J Ind Med 1999 35 246 56 9987557

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Authors
Daniels, R. D., Bertke, S., Dahm, M. M., Yiin, J. H., Kubale, T. L., 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)
  • Division of Cancer Epidemiology and Genetics (US)
  • University of California, Davis (US)
Corresponding author
Daniels, Robert D
ORCID
Venue
Occupational and Environmental Medicine
Publisher
BMJ
Published
2015-02-11
Volume
72
Issue
10
Pages
699-706
ISSN
  • 0007-1072 (ISSN-L)
  • 1351-0711
  • 1470-7926
DOI
10.1136/oemed-2014-102671
PMC
PMC4558385
OpenAlex
W2164631102
Cited by
140
References
49
Citations by year
2026: 9 · 2025: 8 · 2024: 12 · 2023: 23 · 2022: 10 · 2021: 14 · 2020: 22 · 2019: 15 · 2018: 11 · 2017: 10 · 2016: 2 · 2015: 4
FWCI
28.64
Type
journal article
Language
en
Open access
Locations
  • Occupational and Environmental Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health (n01pc35139-25-0-11, CC999999, n01pc35136-24-0-2)
  • U.S. Public Health Service (#U55/CCR921930-02)
  • National Cancer Institute (N01PC35136, N01PC35139, 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, exposure-response relationship, lung cancer, leukemia, cancer mortality, cancer incidence, colorectal cancer, prostate cancer, healthy worker survivor effect, occupational cancer risk, cumulative exposure
MeSH terms
Adult, Aged, Cause of Death, Chicago, Humans, Leukemia, Lung Neoplasms, Male, Middle Aged, Occupational Diseases, Prognosis, Retrospective Studies, San Francisco, Philadelphia, Cohort Studies, Incidence, Proportional Hazards Models, Survival Analysis, Occupational Exposure, Age Distribution, Risk Assessment, Firefighters

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