“What do you want to be when you grow up?” Many boys daydream of a heroic career like firefighting. Everyone knows firefighters are brave rescuers who put life and limb on the line when they rush into blazing buildings; besides intense heat and falling debris, they are enveloped by blinding, suffocating smoke. On the other hand, no boy aspires to an adulthood in which he gets prostate cancer—and yet, firefighting is associated with increased prostate cancer incidence.

Prostate cancer (PCa) is the most common non-skin cancer among men. Roughly one out of every eight men will develop PCa. The most common risk factors are not obviously linked with a man’s work. They include age, family history of prostate or breast cancer, and ethnicity; researchers have also reported evidence for diet, obesity, smoking, genetic mutations, and hormone levels. Does it surprise you to learn that there are also PCa incidence patterns within some jobs? Here are a few examples from a 2018 journal article:

• Industrial work entailing exposure to arsenic and cadmium compounds
• The manufacture and use of the insecticide malathion
• Jobs that expose workers to radiation
• Rubber production
• Agricultural or other outdoor occupations
• Shift work
• Occupations involving whole-body vibrations
• And last but not least, firefighting.^[i]

Firefighting and cancer risk

Exposure to carcinogenic (cancer-causing) chemicals is an occupational hazard of putting out fires. It is ironic that firefighters are expected to be in top physical condition due to the nature of responding to emergencies, and yet their work puts them in the path of toxic substances. These substances can have a long fuse, silently and slowly brewing an internal terrorist for first responders as I blogged twenty years after the 9/11 attacks.

In particular, firefighters are exposed to various chemical hazards. As Poutasse, et al. (2020) write, “During fire suppression activities, firefighters may be exposed to recognized or probable carcinogens, such as select polycyclic aromatic hydrocarbons (PAHs), diesel fumes, and asbestos.”^[ii] To test this, they recruited 56 firefighters in Kansas City, MO to wear special silicone tags that detected 45 unique chemicals, 18 of which “have not been previously reported as firefighting exposures.” They also found the number of fires to which an individual responded was more correlated than his/her rank or years of service.

The Poutasse study is not an isolated example. A recent meta-analysis of 38 studies (1978-2022) reported that while incidence and mortality of various cancers were significantly lower for firefighters, compared to the general population the risk for prostate cancer was significantly higher.^[iii] Although some have theorized that this might be an artifact of PSA screening, two published papers suggest otherwise:

1. Caban-Martinez et al. (2019) explored the cancer-screening activities of Florida fire departments. They found that “preliminary data on Florida firefighters self-reporting prostate specific antigen (PSA) and colorectal cancer screening show lower rates of cancer screening when compared with the general U.S. male population.” Even more disturbing, “One qualitative study exploring perceptions of health and cancer risk among Florida firefighters documented that firefighter would preference a visit to a doctor for an injury rather than for routine care or for chronic disease management.”^[iv]
2. A 2020 paper recognized that firefighters may not be well-informed and knowledgeable about their occupational cancer risk. To remedy this, the author tested an educational intervention designed to motivate participants to discuss their risk with their primary care physician in order to “increase appropriate cancer prevention guidance and earlier cancer screenings…” which would then lead to decreased firefighter cancer mortality rates.^[v]

The lives of our first responders should be treasured as much as the lives of those they rescue. Annual PSA screenings, followed by multiparametric MRI for any suspicious results, are essential for firefighters (and other workers facing hazardous occupational exposure) in order to detect PCa when there is the greatest chance for 100% cancer control. Just as fire safety is based primarily in prevention, don’t wait until your prostate gland is blazing with cancer. An ounce of early detection is worth a pound of cure.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Sritharan J, MacLeod J, Harris S, Cole DC et al. Prostate cancer surveillance by occupation and industry: the Canadian Census Health and Environment Cohort (CanCHEC). Cancer Med. 2018 Apr;7(4):1468-1478
[ii] Poutasse CM, Poston WSC, Jahnke SA, Haddock CK et al. Discovery of firefighter chemical exposures using military-style silicone dog tags. Environ Int. 2020 Sep;142:105818.
[iii] Lee DJ, Ahn S, McClure LA, Caban-Martinez AJ et al. Cancer risk and mortality among firefighters: a meta-analytic review. Front Oncol. 2023 May 12;13:1130754.
[iv] Caban-Martinez AJ, Schaefer Solle N, Santiago KM, Lee DJ et al. Impact of Organizational-level Factors on Cancer Screening Activities in Fire Departments: A Cross-sectional Study from the Sylvester Firefighter Cancer Initiative. Cancer Prev Res (Phila). 2019 May;12(5):335-342.
[v] Hardy T. Firefighter Occupational Cancer Risk: Starting the Conversation. J Cancer Educ. 2022 Aug;37(4):1019-1025.