CancerCancer is a genetic disease—that is, it is caused by changes to

genes that control the way our cells function, especially how they grow and divide.

National Institute of Health

National Cancer institute

DISCLAIMER

The views and opinions expressed in the written

materials and in any of the presentations at this

conference are those of the presenter and do not

necessarily reflect the official policy or position

of the Department of Business and Industry,

Division of Industrial Relations. The Division

does not warranty the materials’ completeness or

accuracy.

Because of themultiple exposures

and the multipleroutes of exposure

— firefighters inhalecarcinogens andcarcinogens are

absorbed throughthe skin — it is alsohighly unlikely forfirefighters to getonly one type of

cancer.”— Grace LeMasters, Ph.D.

University of Cincinnati

Free radicals

• A type of unstable molecule that is made during normal cell metabolism (chemical changes that take place in a cell). Free radicals can build up in cells and cause damage to other molecules, such as DNA, lipids, and proteins. This damage may increase the risk of cancer and other diseases.

• Abnormally high concentrations of free radicals in the body can be caused by exposure to ionizing radiation and other environmental toxins. When ionizing radiation hits an atom or a molecule in a cell, an electron may be lost, leading to the formation of a free radical.

Cancer causes

…the result of environmental exposures that damage DNA.A few examples chemicals firefighters encounter:Asbestos-used in commercial products such as insulation and fireproofing materials, automotive brakes, and wallboard materials.Benzene-used primarily as a solvent in the chemical and pharmaceutical industries, as a starting material and an intermediate in the synthesis of numerous chemicals, and in gasoline.Benzidine-used to produce dyes for cloth, paper, and leather.Formaldehyde-Formaldehyde is a colorless, strong-smelling, flammable chemical that is produced industrially and used in building materials such as particleboard, plywood, and other pressed-wood products. Hexavalent Chromium Compounds-are used widely in metal finishing and chrome plating, stainless steel production, leather tanning, and wood preservatives.Soot- smoke from a fireVinyl Chloride- plastic pipe

Today’s residential fires have more in common with hazmat events than

old-fashioned house fires due to the materials now common in homes such

as plastics and synthetics. Commercial and vehicle fires have highly concentrated

toxicants and dumpster fires contain completely unknown substances

and toxicants.

FIREFIGHTER CANCER SUPPORT NETWORK

Multiple studies, including the soon-to-be-released NIOSH cancer study, haverepeatedly demonstrated credible evidence and biologic creditability for statistically higher rates of multiple types of cancers in firefighters compared to thegeneral American population including:

Testicular cancer (2.02 times greater risk)Multiple myeloma (1.53 times greater risk)Non-Hodgkin’s lymphoma (1.51 times greater risk)Skin cancer (1.39 times greater risk)Prostate cancer (1.28 times greater risk)Malignant melanoma (1.31 times great risk)Brain cancer (1.31 times greater risk)Colon cancer (1.21 times great risk)Leukemia (1.14 times greater risk)Breast cancer in women (preliminary study results from the San Francisco Fire

Department)

NIOSH Fire Fighter Cancer Study-Nov 2013

• Fire fighters had more cancer deaths and cancer cases than expected.

• This increase in cancer was primarily due to digestive, oral, respiratory, and

urinary cancers.

• There were about twice as many malignant mesothelioma cases than

expected. Asbestos exposure is likely in fire fighting and is the primary cause

of this disease.

• Some cancers occurred at a higher-than-expected rate among younger

fighters. For example, fire fighters who were less than 65 years of age had

more bladder and prostate cancers than expected.

• Increased bladder cancer mortality and incidence was observed among

women fire fighters, although there were few bladder cancers observed.

• The number of deaths from all causes combined (i.e., not just cancer)

among fire fighters did not differ from the expected number based on death

rates in the general population.

Routes of exposure

It has become increasingly clear that the two routes of greatest concern for

entry of carcinogens into the bodies of a firefighter are:

Lungs: when firefighters do not wear or prematurely remove SCBA, especially during overhaul.

Dermal absorption: where toxicants are absorbed through the skin.

The lungs are the largest organ in the body in relation to surface area. The estimated total surface area is 1076.39 sq ft. The lungs are highly vascular and contain mucus that can trap substances that are inhaled.

The skin is the body’s second largest organ in area and it is highly absorptive. Some areas of skin are more permeable than others, specifically the face, the angle of the jaw, the neck and throat and the groin. Skin’s permeability increases with temperature and for every 5° increase in skin temperature, absorption increases 400%.

Non chemical causes of cancer:Biological. American Cancer Society

• Several viruses are linked with cancer in humans. Our growing knowledge of the role of viruses as a cause of cancer has led to the development of vaccines to help prevent certain human cancers. But these vaccines can only protect against infections if they are given before the person is exposed to the cancer-promoting virus.

• Viruses are very small organisms; most can’t even be seen with an ordinary microscope. They are made up of a small number of genes in the form of DNA or RNA surrounded by a protein coating. A virus must enter a living cell and “hijack” the cell’s machinery in order to reproduce and make more viruses. Some viruses do this by inserting their own DNA (or RNA) into that of the host cell. When the DNA or RNA affects the host cell’s genes, it can push the cell toward becoming cancer.

Epstein-Barr virus (EBV)

EBV infection increases a person’s risk of getting nasopharyngeal cancer (cancer of the area in the back of the nose) and certain types of fast-growing lymphomas such as Burkitt lymphoma. It may also be linked to Hodgkin lymphoma and some cases of Stomach cancer. EBV-related cancers are more common in Africa and parts of Southeast Asia. Overall, very few people who have been infected with EBV will ever develop these cancers.

Hepatitis B virus (HBV) and hepatitis C virus (HCV)

HBV and HCV can cause the long-term (chronic) infections that increase a person’s chance of liver cancer. In the United States, less than half of liver cancers are linked to HBV or HCV infection.

Human T-lymphotrophic virus-1 (HTLV-1)

HTLV-1 has been linked with a type of lymphocytic leukemia and non-Hodgkin lymphoma called adult T-cell leukemia/lymphoma (ATL).

Human immunodeficiency virus (HIV)

HIV infection has been linked to a higher risk of developing Kaposi sarcoma and cervical cancer. It’s also linked to certain kinds of non-Hodgkin lymphoma, especially central nervous system lymphoma.

What can we do?

• Wear our SCBA throughout the fire incident, from suppression through overhaul. This will limit respiratory absorption.

• Gross decontamination, at the scene of the fire. Wash off the contamination as much as possible to limit skin absorption and respiratory absorption from off gassing from the gear.

• Launder our turnouts after a fire to remove contaminates.

• Do not store contaminated equipment in our vehicles.

• Shower to remove soot and other contaminates as soon as possible after a fire to limit skin absorption.

• Limit exposure to vehicle exhaust.

• Immunizations.

• Hand washing.

• Wear appropriate PPE.

• Health screening to try and identify cancers early.

• Adopt a healthy lifestyle. Increase antioxidants in our diets, limit alcohol and smoking.

Bibliography

• Firefighters cancer support network, August 2013 (V2)

• American cancer society, April 2015

• National Institute of Health, National Cancer Institute