The FASNY-Northwell Health Volunteer Firefighter Cancer Study: What We’ve Been Up To

By Vincenza Caruso, Dr. Anne Golden, Dr. Jacqueline Moline and the Cancer Study Team

Several years have passed since FASNY and Northwell Health joined together to conduct the first all-volunteer firefighter cancer research study in the United States. From 2017-2019, we were tasked with contacting over 1,700 volunteer and combination fire departments in New York State (NYS) to offer them an opportunity to participate in this one-of-a-kind study.

Our goals were to:

1. Determine whether cancer diagnosis or death occurs more frequently among NYS volunteer firefighters than in the general population.

2. Provide estimates for the types of cancers and the numbers of cancers expected to occur among volunteer firefighters in NYS, in order to support cancer prevention and screening programs.

Research methods that have been used successfully to determine cancer incidence in published studies of career firefighters were used to identify cancers diagnosed among volunteer firefighters who served in NYS through linkage with cancer registry records. Recruiting Fire Departments

The first step involved obtaining contact information for all NYS fire departments, for which the NYS Office of Fire Prevention and Control (OFPC) records provided a starting point. An in-depth search of fire department and fire association websites was needed to obtain up-to-date information for department leadership. We started with email, phone and fax outreach in several counties, but in April 2018, we rolled out a massive direct mailing with an invitation to participate to every fire department and fire district in the state. We also presented at local, regional and State meetings and fire expos, created study websites with ready access to information and spread the word via social media, magazines and newspaper articles.

What Kind of Information Was Collected from Fire Departments?

With invaluable assistance from FASNY, Fire Chiefs and Commissioners, we created and utilized a variety of methods for data submission, from electronic methods like secure online databases, to more traditional methods, which involved mailing or faxing paper forms.

Participating departments submitted general departmental and training event information, as well as personnel records for as many past and present members as possible, including full name, date of birth, address, race, ethnicity and service details. Upon completion, departments were asked to complete an optional feedback survey. The OFPC provided National Fire Incident Reporting System (NFIRS) data for 2012-2016 fire runs activity. No health information was requested from the departments; all data about cancer was determined through linkage with NYS Cancer Registry records maintained by the NYS Department of Health.

Participating Fire Departments

Of the 1,732 eligible departments, 218 (13%) enrolled in the study, but 135 (7.8%) ultimately submitted data. Departments that declined or withdrew reported organizational barriers (i.e. lack of time or staff to extract information or lack of requested information from personnel records) and ethical/legal concerns (i.e. doubts about releasing identifiable information for firefighters).

Participating fire departments were mostly all-volunteer (128, 94.8%), with a small proportion being combination (7, 5.2%). They represent 46 counties from every region of NYS, with the highest participation rates in Nassau and Suffolk Counties.

While personnel records were collected for over 18,000 members, 14,821 eligible individuals comprised our master study roster that was submitted to the NYS Cancer Registry for linkage analysis.

“All Hands” On Analysis

The linkage analysis found 1,053 first primary cancers diagnosed among firefighters in our study population from 1976 through 2018:

• 1,053 cancers in the 14,821 firefighters overall = 7.1%
• 983 cancers in 13,073 men = 7.5%
• 70 cancers in 1,728 women = 4.1%
• Average age at cancer diagnosis: 62 years (range 20 – 93 years)
• Average age at cancer diagnosis in men: 63 years; in women: 54 years

We compared the cancers found in NYS volunteer firefighters to the results of three other recent published studies of cancer in career firefighters. In all of the studies, the proportion with cancer among males was higher than the proportion among females.

For female firefighters in our study, breast cancer, any female genital cancer and melanoma of the skin were the most commonly diagnosed cancers. For male firefighters in our study, the most commonly diagnosed cancers were prostate cancer, followed by lung and bronchus, melanoma of the skin, colon excluding rectum, bladder, non-Hodgkin’s lymphoma, and kidney or renal pelvis cancer. Cancer at these sites were similar to the proportions in males from other firefighter studies and increased incidence of cancer at these sites was found in the NIOSH pooled-cohorts study by Daniels, et al. or the meta-analysis by LeMasters, et al.

Decon Kit Raffle

With the ongoing nationwide initiatives to educate firefighters about consistent personal protective equipment (PPE) use and post-incident decontamination, our team developed an on-scene decontamination/contamination reduction kit. The kit was assembled in a 5-gallon pail and included step-by-step instructions for performing decon, as well as a supply list. We randomly chose 12 winning departments for the raffle in July 2019.

The kits and educational message were well-received by those who learned about them and by those who won the raffle. Your department can learn more about these kits and effective decon protocols on our website.

Main Findings of the FASNY-Northwell Health Volunteer Firefighter Cancer Study

  • Cancers occurring in this all-volunteer firefighter population are consistent with the findings from previous studies of increased risks for specific cancers among career firefighters.
  • The results of this study provide unique and important data that:
    • Highlight the importance of continued surveillance of all firefighters.
    • Strengthen the on-going efforts to prevent and mitigate carcinogen exposures by using effective PPE and reducing post-fire contamination.
  • Several of the most frequently diagnosed cancers can be detected and treated early through regular screening by your medical care provider.

What’s Next?

Our future analyses will rely on obtaining mortality data for our population as well as cancer mortality rates for the NYS population for the study period. We need this information to compare the cancer and deaths observed in the study population to what would be expected if risk is equal to the general population. We will also examine fire department data (fire runs, training exposures), firefighter characteristics (age, service details), community-level health indicators and time trends.

We are very grateful to all of the fire departments for their support and participation in this study! Be on the lookout for more details in the coming months.