Safety and Health at Work

Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency (산업안전보건연구원)
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Firefighting and Cancer: A Meta-analysis of Cohort Studies in the Context of Cancer Hazard Identification

  • Nathan L. DeBono (Evidence Synthesis and Classification Branch, International Agency for Research on Cancer) ;
  • Robert D. Daniels (National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention) ;
  • Laura E. Beane Freeman (Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute) ;
  • Judith M. Graber (Department of Biostatistics and Epidemiology, Rutgers School of Public Health) ;
  • Johnni Hansen (Danish Cancer Society Research Centre) ;
  • Lauren R. Teras (American Cancer Society) ;
  • Tim Driscoll (Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney) ;
  • Kristina Kjaerheim (Department of Research, Cancer Registry of Norway) ;
  • Paul A. Demers (Occupational Cancer Research Centre, Ontario Health) ;
  • Deborah C. Glass (School of Epidemiology and Preventative Medicine, Monash University) ;
  • David Kriebel (Lowell Center for Sustainable Production, University of Massachusetts Lowell) ;
  • Tracy L. Kirkham (Occupational Cancer Research Centre, Ontario Health) ;
  • Roland Wedekind (Evidence Synthesis and Classification Branch, International Agency for Research on Cancer) ;
  • Adalberto M. Filho (Evidence Synthesis and Classification Branch, International Agency for Research on Cancer) ;
  • Leslie Stayner (Evidence Synthesis and Classification Branch, International Agency for Research on Cancer) ;
  • Mary K. Schubauer-Berigan (Evidence Synthesis and Classification Branch, International Agency for Research on Cancer)
  • Received : 2022.12.07
  • Accepted : 2023.02.27
  • Published : 2023.06.30
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Abstract

Objective: We performed a meta-analysis of epidemiological results for the association between occupational exposure as a firefighter and cancer as part of the broader evidence synthesis work of the IARC Monographs program. Methods: A systematic literature search was conducted to identify cohort studies of firefighters followed for cancer incidence and mortality. Studies were evaluated for the influence of key biases on results. Random-effects meta-analysis models were used to estimate the association between ever-employment and duration of employment as a firefighter and risk of 12 selected cancers. The impact of bias was explored in sensitivity analyses. Results: Among the 16 included cancer incidence studies, the estimated meta-rate ratio, 95% confidence interval (CI), and heterogeneity statistic (I2) for ever-employment as a career firefighter compared mostly to general populations were 1.58 (1.14-2.20, 8%) for mesothelioma, 1.16 (1.08-1.26, 0%) for bladder cancer, 1.21 (1.12-1.32, 81%) for prostate cancer, 1.37 (1.03-1.82, 56%) for testicular cancer, 1.19 (1.07-1.32, 37%) for colon cancer, 1.36 (1.15-1.62, 83%) for melanoma, 1.12 (1.01-1.25, 0%) for non-Hodgkin lymphoma, 1.28 (1.02-1.61, 40%) for thyroid cancer, and 1.09 (0.92-1.29, 55%) for kidney cancer. Ever-employment as a firefighter was not positively associated with lung, nervous system, or stomach cancer. Results for mesothelioma and bladder cancer exhibited low heterogeneity and were largely robust across sensitivity analyses. Conclusions: There is epidemiological evidence to support a causal relationship between occupational exposure as a firefighter and certain cancers. Challenges persist in the body of evidence related to the quality of exposure assessment, confounding, and medical surveillance bias.

Keywords

Acknowledgement

This work was supported by the National Institutes of Health, including the National Cancer Institute and National Institute of Environmental Health Sciences [NIH-NCI U01CA033193].

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