Firefighter cancer research: 5 reasons it moves so slow

Funding and the unseen groundwork lead the barriers to faster firefighter cancer research and results

More research is needed on cancer and firefighting. The conclusion has been drawn independently from several fire service groups, those who set the National Research Agenda and the Firefighter Cancer Support Network.

Even past research concludes more research on the topic needs to be done. So where is it? Why isn't cancer research among firefighters moving faster?

First, firefighter cancer research is moving fast — at least fast for the world of science. Research, particularly good, high-impact research, is time consuming and costly to conduct.

This can be frustrating to firefighters who are in a field that requires split-second decisions and quick turn-around times.

Sometimes, what seems like a simple question that would be easy to answer can take years to get. There are five main reasons for this.

Research is expensive
At first glance, it might seem like research shouldn't be a costly undertaking. A survey costs the amount of paper and a database should be something you can enter in any Excel spreadsheet, right?

If only it were that easy.

Personnel and infrastructure costs are necessary for every step of the scientific process from designing a study, to creating databases, to entering data, to analyzing the results.

For every funded survey a firefighter takes, hundreds or thousands of hours have gone into identifying the exact questions, sometimes buying rights to use the measures, developing the data collection tool, getting approval for the study and getting the survey into a firefighter's hands.

For cohort studies, the hundreds or thousands of hours go into defining the variables to be collected, data entry protocols, institutional approval, and extracting and entering the data.

Funding is limited and difficult to get
The National Institutes of Health, which funds more than any other group in the United States, awards about $4.5 billion in project funding every year. This seems like it would be sufficient to answer any firefighter health research question in existence.

The challenge is that they fund research from basic bench research to public health and community interventions — and have to cover topics for all different groups. While there are about 1.1 million firefighters, that is only 0.3 percent of the total U.S. population.

Convincing scientific review committees of the importance of such a small sample is difficult. Funding also is extremely competitive with less than 20 percent of NIH applications being funded — most after a second submission — and each submission is a compilation of several hundred hours of work.

It takes a team
Very rarely (if ever) is a project funded to just one scientist. While one researcher might know a good deal about the topic of cancer, if they don't understand the exposures and environments of the fire service, the study they design and conclusions they draw might be useless.

Research teams are more commonly made up of several different types of scientists who each know their own area well, whether it is epigenetic testing or statistics.

In this field, it's also important that the researchers understand the fire service, which has its own language in a lot of ways. Just as research has to be translated into useable information for the fire service, fire service language and factors have to be translated for scientists.

Cancers are rare and develop over years
We know that firefighters are at elevated risk for many types of cancers. Yet, any specific type of cancer is relatively rare and it is impossible to predict exactly who will get cancer and when.

For exposures that occur today or tomorrow, the latency period (the time between exposure and disease) can be extremely long. Unlike some diseases, such as cardiovascular disease, where you can see the plaque building prior to a cardiac event, cancers aren't currently detected until they are present — although, research is working on developing markers.

Sampling matters
It has been said that if you know one fire department well, you know one fire department well. While there are some similarities across departments, regions and types of organizations, there are almost as many differences — and understanding how to measure that is important.

Even within one department, there are stations that never sleep and those that rarely get a call.

The practices of the firefighters also make a difference when it comes to limiting exposures with tools like SCBAs and clean gear. Grouping all firefighters into one category likely masks the relevant results.

So, while you want the sample to be similar enough to make sense as a group, it also has to be large enough to know what you are finding (or not finding) is not because there aren't enough people in the study.

It may seem like research is ignoring the issue of firefighter cancer or that progress is moving at a snail's pace, but that is not the case. The seemingly repetitive calls for more research are an important part of the process and provide the background to highlight the importance of this topic for the fire service.

In the meantime, there is enough known about the topic to warrant education, prevention efforts and practices with steps as simple as cleaning gear, keeping SCBA on while on the scene (even when the air is "clear" given that is the time the smallest of particles are floating around looking for a place to lodge), cleaning gear as soon as possible after a call, using wipes to clean skin, washing hoods and avoiding having off-gassing gear in enclosed areas.

Prevention also has to focus on the personal risk factors like fitness, nutrition, tobacco cessation and adequate sleep. While all the details of the hows, whys and whens are being answered by research, every firefighter already has the tools to start decreasing their own risks.

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