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Modifiable risk: Firefighter cancer prevention

To reduce an individual firefighter’s relative risk of contracting cancer, they must limit risk factors on and off the fireground


The relative risk of firefighting and other modifiable risk factors highlight the importance of changing the things that can be changed.


Can science tell you exactly how much being a firefighter increases your risk for cancer? In a word, no.

When Dr. Doug Daniels and his team at NIOSH investigated cancer diagnoses and death among firefighters in Chicago, Philadelphia and San Francisco, they found that firefighters were 9 percent more likely to contract cancer and at 14 percent higher risk of dying from cancer than the general population.

While these statistically significant findings are important, they only tell the start of the story. When you look at specific types of cancer, the size or magnitude of the relationships vary quite a bit between cancers and even between his study and others.

While Daniels found that firefighters were at a generally lower risk of contracting multiple myeloma compared to the general population, the risk of contracting mesothelioma was more than double that of the general population. While the overall risk estimates for contracting cancer and dying of cancer Daniels describes is across all cancers in general, risk of specific types of cancers vary significantly.

At the same time, different studies have different findings. A 2015 study by Dr. Rebecca Tsai and colleagues exploring the California cancer registry didn’t agree with the findings of Daniels. Tsai found the risk of multiple myeloma to be 35 percent higher among firefighters, rather than lower.

PPE use, health practices factor into cancer risk

So what is your individual risk? No general scientific study can tell you that. It depends on your individual risk factors, genetics and the health choices you make on a daily basis.

For instance, the risk of liver cancer is estimated to be 20-30 percent higher among firefighters. Obesity, however, doubles the risk of developing the same type of cancer as well as similar increased risks of esophageal, gastric and kidney cancers. So firefighters who are overweight are likely even more at risk compared to healthy weight firefighters.

Consuming more than 3.5 servings of alcohol a day is linked to a 2-3 fold increased risk of developing head and neck cancer and a 50 percent higher risk of breast and colorectal cancers.

By comparison, heavy smokers are more than 100 times more likely to develop different types of lung cancer compared to non-smokers. Firefighters who smoke face both the exposure risks and the smoking risks.

The U.S. Surgeon General estimates that exposure to environmental tobacco smoke in the home increases a non-smokers chances of developing lung cancer by 20-30 percent.

Even looking specifically at the risk of firefighting likely varies based on the practices, policies and actions of the department and individual. Relationships that were statistically significant overall in the Daniels study were not necessarily significant in each of the three departments. What firefighters are exposed to in a given area, how they decon their gear, how long they wear their bunker gear and SCBAs all can vary.

Effective firefighter cancer prevention

The fact that the relative risk of firefighting is lower than the threat of other risk factors doesn’t mean the threat associated with firefighting isn’t real. These numbers should not be used to downplay the cancer risk related to firefighting.

Even without knowing what any one firefighters’ specific risk is, the data is clear that firefighting leads to increased rates of cancer. Instead, the relative risk of firefighting and other modifiable risk factors highlight the importance of changing the things that can be changed.

Given firefighters are already at risk, it is even more important to avoid tobacco, be proactive about fitness and nutrition, limit binge drinking and follow PPE best practices. For cancer prevention to be effective in the fire service, it has to include all aspects of modifiable risk factors on and off the fireground.

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.