Dear friends,
As I told you via Facebook ('UFF - Unit of Forest Fires' and 'Mastros de Fogu') this post will regard the topic: cancer & firefighters. As cancer survivor Keith Tyson says: "What we are learning is that we MUST get our heads out of the sand and begin tu put a MAJOR EMPHASIS on CANCER prevention and protection within the Fire Service" ('The Firefighter & the Ostrich!").
First of all, I warn you that this post is written employing structural firefighters cancer-related information. Meaning that it is not wildland firefighters-related data. As every wildland firefighter should know, the fire phenomenon is not really different either inside a room, or in the forest (the fundamental processes developed there are the same). On the contrary, the burned materials are not equal: while in the forest the main element is wood, in structural fires fire burns plastic, concrete, fiberglass, iron, and many other chemichal-compounded materials. Therefore, structural firefighters (just 'firefighters') are more exposed to suffering cancer because of the toxic products generated in the combustion (either complete or incomplete) of those materials. Moreover, we never fight confined fires, so aerial particles always dissipate as fast as weather conditions (overall, mixing height conditions) permit.
So, even though wildland firefighters are not represented in any of the papers I will quote in this post, it is true that some of the recommendations are absolutely useful and will also prevent that little likelihood (little compared with structural firefighters) of suffering cancer. Breathing postcombustion air particles is always unhealthy.
Let's do it!
"Most firefighter line-of-duty deaths are due to cardiovascular disease and occur during the active phase of fire suppression (Alarie Y. Toxicity of fire smoke. Crit Rev Toxicol. 2002; 32:259-289). Although most firefighter studies and statistics have looked almost exclusively at on-duty deaths, fea have looked at the long-term effects of career firefighting on health and longevity.
A Canadian study indicated that firefighters with 30 years of employment or more had a significantly increased mortality risk of colon cancer, kidney cancer, brain cancer and leukemia. In addition, firefighters with 40 years of employment or more had a significantly incresed risk of bladder cancer in addition to the risks previously described (Kales SN, Soteriades ES, Christophi CA, et al. Emergency Duties and Deaths from Heart Disease among Firefighters in the United States. NEJM. 2007;356:1207-1215). Similar findings were noted in a study of Massachusetts firefighters (Ma F, Fleming LE, Lee DJ, et al. Mortality in Florida Professional Firefighters, 1972 to 1999. Am J Ind Med. 2005;47:509-517). The prevailing theory is that repeated exposures to toxins on fire ground may result in the development of selected types of cancers"
[...]
CO
Typically, a phase of decreased oxygen content in the blood (hypoxemia) follows CO exposure. The effects of CO-mediated hypoxemia are dependen on any underlying disease that might be present, such as emphysema or heart disease (Mannatoni PF, Masini VE. Carbon monoxide: the bad and the good side of the coin, from neuronal death to anti-inflammatory activity. Inflammatory Research. 2006;55:261-273). These periods of hypoxemia and re-oxygenation often result in the formation of dangerous chemicals called 'free radicals', which causes oxidative stress, as well as cell and tissue damage (Zang J, Piantadosi CA. Mitochondrial oxidative stress after carbon monoxide hypoxia in the rat brain. Journal of Clinical Investigations. 1992;90:1193-1199 & Van der Vaart H, Psotma DS, Timens W, et a. Acute effects of cigarette smoke on inflammation and oxidative stress: a review. Thorax. 2004;59:713-721).
Oxidative stress has been associated with the development of many diseases, including atherosclerosis, Parkinson's disease and Alzheimer's disease (Rice-Evans CA, Gopinathan V. Oxygen toxicity, free radicals and antioxidants in human disease: biochemical implications in atherosclerosis and the problems of premature neonates. Biochemical Essays. 1995;29:39-63). Thus, exposure to CO (either acute or chronic) may be a risk factor for the development of cardiovascular and neurological diseases.
In a 2005 study, researchers in Minneapolis evaluated 230 victims of CO poisoning and found that myocardial injury was common in moderate to severe CO poisoning. These same 230 patients were followed for an average of 7.6 years after their exposure. Initially, 85 (37%) patients had an associated myocardial injury, such as ECG changes and elevated cardiac biomarkers, associated with the poisoning. Interestingly, of the 85 who had myocardial injury, 32 (38%) eventually died during the study. In contrast, only 22 (15%) of the 145 patients who did not sustain myocardial injury eventually died (Henry CR, Satran D, Lindgren B. et al. COHb% as a marker for cardiovascular risk in never smokers: Results from a population-based cohort study. Scandinavian Journal of Public Health. 2006;36:609-615).
CO poisoning can interrupt oygen delivery to the brain, causing brain hypoxia. This is later followed by oxidative stress that can damage sensitive brain tissue. The detrimental effects of hypoxia and oxidative stress can be either temporary or permanent.
[...]
OTHER TOXINS
Smoke is a complex mixture of airborne solid and liquid particulates and gasses that develop when materials undergo vaporization or thermal decomposition (Stefanidou M, Athanaselis S, Spillopoulou C. Health impacts of fire smoke inhalation. Inhal Toxicol. 2008;2:35-39). This vaporization and decomposition can liberate various toxins. Although the effect of these agents is unclear, exposure to some (e. g., aromatic hydrocarbons) has been linked to cancer development.
PREVENTION AS SOLUTION
The solution to mitigating the toxic effects of smoke and fireground risks, and thus many of the occupational risks of firefighting, is through prevention and treatment. This can be achieved through several efforts, including use of safe firefightin tactics (including safe mop-up) that mitigate unnecessary risks and exposures, and use of proper protective equipment (PPE) and clothing.
Other preventive practices include:
- Ensured adequate nutrition and hydration.
- Attainment of a satisfactory level of physical fitness.
- Organized firefigher rehabilitation practices"
(Where There's Smoke, There's Far More than Fire. NFPA 1584. 2010).
After these interesting quotes on that article, I would like you to keep in mind some of these others:
"For the years 2008-2010, 29% of our currently ACTIVE members [within a 2018 firefighers crew] have been diagnosed with some type of CANCER ISSUE!
[...]
We must insure that our members have CLEAN PPE, INCLUDING their Nomex hoods, gloves and sweat bands in ther helmets! The data is starting to add up more and more that dirty gear is more responsible for many of our issues than we thought in the past. Look at the types of cancers: testicular and prostate cancer = dirty pants, thyroid cancer = dirty hoods, brain and NS = dirty helmets (when was the last time you cleaned your helmet?). Again, what toxins are in the gear after a fire ARE being absorbed thru our skin as we sweat and our pores open up".
(Keith Tyson. The Firefighter & the Ostrich! 2011).
"One cancer that firefighters nay not realize they have a higher risk for is bladder cancer. We understand the importance of wearing proper protective equipment (PPE) during fire attack, but we must stress the importance of continued use of PPE during all phases of firefighting, including mop-up, because it's this long-term exposure to the products of complete and incomplete combustion that increases the risk for bladder cancer.
Firefighters are among the most prominent occupational groups at increased risk for bladder cancer. Surprisingly, many firefighters and their physicians are unaware of their risk for this cancer. Men get screened for prostate and colon cancers; they understant that they're not immune from lung cancer if they smoke or are exposed to tobacco smoke; and they watch for signs of skin cancer. Yet one of the most deadly cancers is not on their cancer watch list".
(Dr. Barry Stein, Michael Dubron. Firefighters & Bladder Cancer: Prolonged exposure to burning debris increases your risk. Fire Rescue Magazine. 2010).
"The connection between fire fighting and cancer is real and there is scientific data to support our position. But we can't stop there; we must continue to learn more so we can prevent our members from contracting this horrible disease and help them if they do".
(Fighting Fires. Fighting Cancer. Working to deat - Leading Causes of Death Among First Responders. 2008).
And that is all the info I wanted to share with you. I think it is such an interesting topic, which is being strongly developed by many different scientific researching teams. One thing it is clear to me: Even though we do not fight structural fires, clean PPE is fundamental.
Thank you very much to Dr. Adam Watts, who sent me many cancer-related information from the Firefighter Cancer Support Network. Also thanks to that organization, which fights to prevent Fire Services about cancer risk.
PS: As I told you via Facebook, if you want me to send to you some of these Firefighter Cancer Support Network-edited brochures, you just have got to both share either this post (http://merencianosardegna.blogspot.com.es/2013/09/cancer-info-do-we-now-enough-about-it.html) or the entire blog (http://merencianosardegna.blogspot.com.es/) on Facebook and leave one comment either here in the blog's page or in one of the two Facebook Groups' posts on which I update blog's data). Then, just write to me via private message on Facebook and we will figure out how I will make them arrive to you.