By Roberta Burkhart
Pittsburgh Post-Gazette
PITTSBURGH — Firefighters face danger with every call — not just from flames and falling debris, but from something more insidious. Cancer-causing agents can cling to their gear, soak into their skin and accumulate over time.
Among those risks, melanoma — the deadliest form of skin cancer — is emerging as a top concern.
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A growing body of research supports this alarm. A May 2023 review of case-control studies found that career firefighters are significantly more likely to develop melanoma than the general population.
The review, which pooled results from multiple studies and was published in the Journal of the American Academy of Dermatology, showed that in 80% of the data analyzed, firefighters had higher odds of developing melanoma, sometimes by as much as three to five times.
Why the risk?
It’s not just the sun exposure that firefighters endure during practices, inspections or rescue efforts, although that danger should not be downplayed, said Jeremy Udkoff, a Mt. Lebanon dermatologist whose practice provided free skin checks earlier this month to members of that community’s fire and police departments.
Most skin cancers are caused by too much exposure to ultraviolet light, which emanates from the sun, tanning beds, sunlight lamps and other sources, per the Centers for Disease Control.
During training exercises, controlled outdoor burns and just plain hanging out in the sun, firefighters — along with everyone else — should wear sunscreen to protect themselves from too much sun exposure, Udkoff said.
But for firefighters, the bigger threat is chemical exposure, from smoke, soot and the fumes released by burning synthetic materials, he added.
In the past, most home furnishings traditionally were made from natural materials like cotton, wool and wood, said Mt. Lebanon Fire Chief Kurt Christofel, as he was waiting in the firehouse July 11 for his skin check. The rise of plastics and other synthetic materials has led to more carcinogenic gases being released when they burn.
The elevated risk among firefighters results from a “three-strike” exposure scenario: toxic chemicals, ultraviolet (UV) radiation and occupational stress, said Joe Tung, UPMC’s director of the clinical trials unit and associate director of the dermatology residency program. Tung also is team dermatologist for the Pittsburgh Penguins.
“As these brave men and women rush into these fires, they are inhaling smoke,” Tung said. “And in that smoke, you have a lot of cancer-causing toxins.”
They may inhale a variety of dangerous chemicals: benzene, polyaromatic hydrocarbons (PAHs), PFAs (per- and polyfluoroalkyl substances), formaldehyde and asbestos, he said, adding that these carcinogens also can enter the body through the skin — especially when it’s hot and sweaty, conditions common in full turnout gear.
“It’s basically this toxic stew that can seep through sweat into their skin,” Tung said.
Protective gear’s hidden risk
The very protective equipment designed to shield firefighters from flames may increase risk when it comes to skin exposure.
A study conducted by researchers from the Fire Safety Research Institute and others and published in 2022 in the International Journal of Hygiene and Environmental Health indicates firefighters’ exposure to volatile organic compounds produced during both structure and training fires can occur through the skin.
And when the skin becomes moist from sweat, the absorption of toxins increases.
So while modern protective gear is better at shielding firefighters from heat and flame, the thicker and heavier turnout kits have also made those who wear them much hotter, Christofel said.
“The hotter you get, the more you sweat,” Christofel said. “And when your pores open, it lets the carcinogens in.”
The Fire Safety Research Institute urges departments to highlight these risks to members and institute protocols for cleaning the skin as rapidly and thoroughly as possible after exposure to smoke or fire.
Mt. Lebanon Fire Department emphasizes post-call decontamination with the departmental motto, “shower within the hour,” Christofel said. Firefighters are expected to wash themselves, change their clothes and decontaminate their gear as soon as possible after exposure.
Getting regular skin checks is important too, as skin cancer doesn’t always appear where people expect.
“Melanoma can happen anywhere, even on skin that’s not exposed to the sun,” Udkoff said. But in his experience, the back, head and neck — common areas of exposure or coverage gaps in gear — are particularly vulnerable.
Udkoff recommends that firefighters, and everyone, perform monthly self-checks, wear long sleeves under gear, use hats and sunscreen during outdoor activity and ask someone to check their back for changes.
Doctors from Mt. Lebanon Dermatology checked 16 members of the city’s fire and police departments for suspicious moles and other skin conditions on July 11 . Of those members, five received follow-up recommendations for further skin testing.
The practice is across the street from the fire station and Udkoff said he wanted to give back to the men and women who put their lives on the line for the community. “We see every day how early detection saves lives.”
“It was really hard to say no,” said Christofel. “We take care of our folks, and this was another way to do that.”
Andrew Flynn, 50, a volunteer firefighter for the department for the past two years, took advantage of the screening.
“I’ve already had a patch of skin cancer removed,” he said. “You can’t be too careful.”
Flynn said another volunteer who joined around the same time he did was diagnosed with breast cancer after a different department-organized screening. “Joining the department was life-saving for her,” he said.
Stress effect
In addition to regular screenings, de-stressing is another important way to protect against the threat of cancer, Tung said.
“Your body naturally has a defensive mechanism against some of these skin cancers forming,” he said. Working long hours, the physical and mentally challenges of a high-stress environment and lack of quality sleep can “wear down that defense system and your immune system and create this perfect storm for cancers to develop.”
And skin cancer isn’t the only risk, Tung said. Firefighters carry higher risk of lung, prostate and blood cancers as well.
This is backed up by a 2010 National Institute for Occupational Safety and Health study of 30,000 career firefighters that found they had a 9% increase in cancer diagnoses and a 14% increase in dying from cancer when compared to rates among the rest of the U.S. population.
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