By Todd LeDuc
The National Cancer Institute estimates that the lifetime risk of a member of the United States general population being diagnosed with cancer at some point during their lifetime is approximately 39.3 percent. The largest U.S. study that has examined occupational cancer impacts to U.S. firefighters was conducted by the National Institute of Occupational Health & Safety (NIOSH). That study concluded that firefighters had a nine-percent elevation of occupational cancer risk and 14-percent increase in overall mortality than members of the general population.
Perhaps the scariest notion of fire service cancer is that it can lay silent within the body as it continues to grow. In work reported by Christina Chun, MPH reported that some cancers can form and grow undetected for 10 years or more, making diagnosis and treatment challenging. Additionally, many cancers are asymptomatic in their early stages, which is why regular screenings are so important.
Typically, cancer signs and symptoms first become obvious when the cancerous tumor or mass has grown large enough that it begins pushing against nearby organs and tissue, blood vessels, and nerves. Some cancers are fast moving, such as liver and pancreatic cancers; prostrate cancer, on the other hand, is typically slow moving. In many cases, when signs and symptoms are appreciable the cancer may have already spread beyond the primary site of origin, providing a late start to treatment and offering less optimal outcomes. We know that survival rates are the highest for cancers that are identified as either “pre-cancerous” or still encapsulated in their primary site/organ of origin.
It is incumbent on every member of the fire service to make their own health a priority with regard to early detection of preventable occupational health risks. This includes assuring in addition to preventative practices that reduce health risk but also an annual occupationally appropriate firefighter medical exam. Survey data from the International Association of Fire Chiefs published in 2016 points to 80 percent of career firefighters and 60 percent of volunteers receiving some type of annual medical exam. Unfortunately, those numbers drop dramatically when inquiring if they received an NFPA 1582 occupational firefighter exam and certainly not an enhanced occupational exam with early detection imaging and other advanced testing. Oftentimes, health care providers are not familiar with the unique occupational health risks that firefighters and first responders face. Many providers default to the U.S. Preventative Health Task Force recommendations that are aimed at general population and not firefighters. The International Association of Fire Chiefs attempted to address this with their Health Care Providers Guide to Firefighter Physicals. The First Responder Center of Excellence also has established a clearing house of resources https://www.firstrespondercenter.org/physicals/ .
We also know that, unfortunately, sudden cardiac death continues to plague the fire service. Recently, the IAFC launched an awareness campaign of “If You Don’t Feel Well, Don’t Make it Your Farewell.” This cardiac risk is from a host of contributing factors such as dehydration, vascular stiffness, underlying modifiable risk factors, enlarged left ventricle, and high blood pressure, to name a few. The importance of early and annual screening to identify and address modifiable risk factors cannot be understated as a vital component to address the scourge of firefighter cardiac death to the extent possible.
We must continue to focus on prevention with exposure reduction strategies, exposure decontamination practices, health living, and commitment to occupationally specific annual medical exams if we are to be successfully in addressing elevated cancer risks for firefighters.
Todd J. LeDuc, MS, CFO, FIFirE, retired after nearly 30 years as assistant fire chief of Broward County, Florida, an internationally accredited career metro department. He served as chief strategy officer for Life Scan Wellness Centers, a national provider of comprehensive physicals and early detection exams. He has served as a member of the International Association of Fire Chief’s Safety, Health & Survival Section for over a decade and is currently secretary of the section. He is a peer reviewer for both professional credentialing and agency accreditation. He is editor of Surviving the Fire Service (Fire Engineering Books) and serves on numerous advisory boards and publications. He can be contacted at Todd. [email protected]