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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)
Open accessAbstract
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 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]
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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. (2014) · Occupational and Environmental Medicine · doi:10.1136/oemed-2013-101662 · Cited by 334
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Wildland firefighter smoke exposure and risk of lung cancer and cardiovascular disease mortality
Navarro, K. M., Kleinman, M. T., Mackay, C. E., Reinhardt, T. E., Balmes, J. R., Broyles, G., Ottmar, R. D., Naeher, L. P., & Domitrovich, J. W. (2019) · Environmental Research · doi:10.1016/j.envres.2019.03.060 · Cited by 207
Fent, K. W., Alexander, B. M., Roberts, J., Robertson, S. A., Toennis, C. A., Sammons, D. L., Bertke, S. J., Kerber, S. I., Smith, D. L., & Horn, G. P. (2017) · Journal of Occupational and Environmental Hygiene · doi:10.1080/15459624.2017.1334904 · Cited by 182
Self-citationStec, A. A., Dickens, K., Salden, M., Hewitt, F., Watts, D. P., Houldsworth, P. E., & Martin, F. L. (2018) · Scientific Reports · doi:10.1038/s41598-018-20616-6 · Cited by 180
Risk of Cancer Among Firefighters in California, 1988–2007
Tsai, R. J., Luckhaupt, S. E., Schumacher, P., Cress, R., Deapen, D., & Calvert, G. (2015) · American Journal of Industrial Medicine · doi:10.1002/ajim.22466 · Cited by 139
Trowbridge, J., Gerona, R. R., Lin, T., Rudel, R. A., Bessonneau, V., Buren, H., & Morello-Frosch, R. (2020) · Environmental Science & Technology · doi:10.1021/acs.est.9b05490 · Cited by 116
Metadata
- 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
- 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
- green
- www.ncbi.nlm.nih.gov
- 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 › Medicine › Public Health, Environmental and Occupational Health › 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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