Recently, the United States Preventative Task Force announced its recommendation to begin colon cancer screening at age 45 instead of its previous age of 50. This comes on the heels of the American Cancer Society recommending the same lowering of age for first screening due to an increased prevalence among younger patients.
While attending the National Cancer Symposium this past week in Orlando, Florida, a dear friend and colleague Chief Bryan Frieders, President of the Firefighter Cancer Support Network, addressing the crowd, made the point that in many areas on the occupational fire service cancer front, we’re failing. (see image below) Amongst his five examples, one cited the need to further embrace change he noted the need for both great access to occupationally appropriate annual physicals for firefighters and enhanced screenings that are more in line with the elevated risk that firefighters face compared with other occupations and general populations. Typically, many health care providers continue to default to generalized screening recommendations from the U.S. Preventative Health Task Force (USPHTF) recommendations. These recommendations are for general population/primary care and not intended to address unique and specific occupational health risks firefighters and first responders are exposed to. The colonoscopy recommendation discussed early in this article are an excellent example of the disparity between general population USPHTF recommendations and that for firefighters. According to NIOSH, firefighters have an 1.21-times elevated rate of colon cancer (www.hygenal.com). The National Fire Protection Association (NFPA) set industry standards, meanwhile, typically relies on existing research recommendations based on work specific to first responders.
One example of this is the enhanced screening recommendations are those from the Better Heart project led by Dr. Denise Smith from Skidmore College. Recognizing that a significant number of cardiac line-of-duty deaths had the presence of both underlying cardiac heart disease and left ventricular enlargement, recommendations have evolved to screen firefighters with cardiac echocardiogram and a coronary calcification baseline scoring. This study was supported by the National Fallen Firefighters Foundations and the Federal Emergency Management Agency Assistance to Firefighter Grants funding.
Additionally, enhanced imaging has been responsible for cancer early detection finds, such as a recently reported case of a Stage 3 kidney cancer in a Albemarle County (VA) firefighter. The Life Scan Wellness Centers physical, which uses NFPA 1582 as its baseline exam also incorporated NFPA 1583 assessment and ultrasound imaging, ultimately detected the kidney mass, allowing for intervention and recovery and return to work.
As research continues to evolve our understanding of unique firefighter and first responder health risks, our access to occupational-specific medical exams and screenings must also continue to evolve.
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. LeDuc@lifescanwellness.com.