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Breast cancer in the fire service: Beyond pink tees

The data linking firefighting and breast cancer is slim but growing, and this cancer strikes men as well as women


October is breast cancer awareness month. What does that mean for the fire service beyond pink shirts and pink fire trucks? While breast cancer awareness in the community is important – and a noble effort for firefighters to undertake – the topic should resonate with firefighters beyond just awareness.

It is estimated that one in eight women will get breast cancer in their lifetime. Not surprisingly, data on the relationship between firefighting and breast cancer is relatively slim.

With women making up an estimated 3 to 5 percent of the fire service, collecting data from a representative sample to compare with the general population is a challenge. Small sample sizes of women in any given study make it challenging to find a statistically significant relationship, and most breast cancers occur in women.

What is surprising is that a significant relationship has been noted in the literature – but it was among men. In the general population, less than 1 percent of men get breast cancer.

In a 2005 study by Ma and colleagues, they found that male firefighters were nearly 7.5 times more likely to die from breast cancer than non-fighters. The hypothesis for the reason is that breast cancer in males is rarely caught until the late stages.

What does this mean for the empirical evidence around breast cancer among women firefighters? The same mechanism that would cause breast cancer in men is thought to lead to the increased risk among women.

Further research on breast cancer in firefighters

In animal studies, many of the known carcinogens firefighters face during fires and at the firehouse have been linked to mammary-gland tumors, which suggests a biological link between firefighting and breast cancer.

In short, a likely reason we have not yet found a relationship between firefighting and breast cancer in women firefighters is that the question has not been researched enough yet in a way that provides any confidence in the results.

Work is being undertaken to more closely examine the relationship between breast cancer and firefighting. Scientists at the San Francisco Firefighter Cancer Prevention Foundation, UC Berkeley and UC San Francisco are studying that relationship through bio-monitoring.

Our team at the Center for Fire, Rescue, & EMS Health has funding through the Fire Prevention & Safety’s Research and Development mechanism to develop an epidemiologic cohort study focused on women in the fire service. We will examine several health issues including breast and other reproductive cancers.

In addition, Dr. Burgess from the University of Arizona and his colleagues, also through funding from the Fire Prevention & Safety’s Research and Development mechanism, are developing the framework for a large scale cancer study that will track exposures, firefighters and recruits across time to examine the development of cancers.

Cancer Prevention

While the science has not yet arrived at a firm estimate at the amount of risk firefighters face related to breast cancer, enough evidence exists to warrant prevention efforts for breast and other cancers.

Prevention efforts on the fireground need to focus on limiting exposures through consistent and regular use of SCBAs all the way through overhaul. Post incident, gear (especially gloves and hoods) need to be decontaminated and dirty gear needs to be kept out of personal vehicles, cabs of the trucks and living spaces.

Firefighters should clean as much visible soot as possible as soon as possible after a fire. Exposure to diesel exhaust should be limited as much as possible – for stations that have an exhaust mitigation device for trucks, use it.

The likely risks that lead to increased rates of many cancers among firefighters are complex and multifaceted; prevention efforts are the same. While reducing and exposures to carcinogens takes time and effort and can be inconvenient, they are far less difficult than a cancer diagnosis.

So, as you’re putting on your pink T-shirt or looking at the pink fire truck, remember that breast cancer is not just something that affects the community – it’s a fire service issue as well.

Sara Jahnke, PhD, is the director and a senior scientist with the Center for Fire, Rescue & EMS Health Research at the National Development & Research Institutes - USA. With over a decade of research experience on firefighter health, Dr. Jahnke has been the principal investigator on 10 national studies as well as dozens of studies as a co-investigator. Her work has focused on a range of health concerns, including the health of female firefighters, behavioral health, risk of injury, cancer, cardiovascular risk factors, and substance use, with funding from the Assistance to Firefighters Grant R&D Program, the National Institutes of Health and other foundations. Jahnke has more than 100 publications in the peer-reviewed medical literature. Awards include the 2019 Endowed Lecture at the annual conference of the American College of Epidemiology; the 2018 President’s Award for Excellence in Fire Service Research as well as the Excellence in Research, Safety, Health & Survival Award, both from the International Association of Fire Chiefs (IAFC); and the 2016 John Granito Award for Excellence in Firefighter Research from the International Journal of Fire Service Leadership and Management. Connect with Jahnke on LinkedIn, Twitter or via email.