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      Cancer risk and mortality among firefighters: a meta-analytic review

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          Abstract

          Background

          Firefighting is a hazardous occupation that is associated with an increased risk of select cancers. The number of studies has grown in recent years allowing for a synthesis of findings.

          Methods

          Following PRISMA guidelines, multiple electronic databases were searched to identify studies on firefighter cancer risk and mortality. We computed pooled standardized incidence risk (SIRE) and standardized mortality estimates (SMRE), tested for publication bias, and conducted moderator analyses.

          Results

          Thirty-eight studies published between 1978 and March 2022 were included for final meta-analysis. Overall, cancer incidence and mortality were significantly lower for firefighters (SIRE = 0.93; 95% CI: 0.91-0.95; SMRE = 0.93; 95% CI: 0.92 - 0.95) compared to the general population. Incident cancer risks were significantly higher for skin melanoma (SIRE = 1.14; 95% CI:1.08 - 1.21), other skin cancers (SIRE = 1.24; 95% CI:1.16-1.32), and prostate cancer (SIRE = 1.09; 95% CI: 1.04-1.14). Firefighters showed higher mortality for rectum (SMRE = 1.18; 95% CI: 1.02-1.36), testis (SMRE = 1.64; 95% CI: 1.00-2.67), and non-Hodgkin lymphoma (SMRE = 1.20; 95% CI: 1.02-1.40). There was evidence of publication bias for SIRE and SMRE estimates. Some moderators explained variations in study effects, including study quality scores.

          Conclusion

          Firefighters are at higher risk for several cancers; to the extent that some (e.g., melanoma and prostate) are screening amenable, more study into firefighter-specific recommendations for cancer surveillance is needed. Moreover, longitudinal studies with more detailed data on the specific length and types of exposures are necessary, as well as on unstudied subtypes of cancers (e.g., subtypes of brain cancer and leukemias) are needed.

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          Most cited references68

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              Operating Characteristics of a Rank Correlation Test for Publication Bias

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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Oncol
                Journal ID (iso-abbrev): Front Oncol
                Journal ID (publisher-id): Front. Oncol.
                Title: Frontiers in Oncology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2234-943X
                Publication date (Electronic): 12 May 2023
                Publication date Collection: 2023
                Volume: 13
                Electronic Location Identifier: 1130754
                Affiliations
                [1] 1 Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami , Miami, FL, United States
                [2] 2 Sylvester Comprehensive Cancer Center, University of Miami Health Systems , Miami, FL, United States
                [3] 3 Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami , Miami, FL, United States
                [4] 4 Department of Physical Medicine and Rehabilitation, Leonard M. Miller School of Medicine, University of Miami , Miami, FL, United States
                [5] 5 Department of Medicine, Leonard M. Miller School of Medicine, University of Miami , Miami, FL, United States
                Author notes

                Edited by: Guowen Song, Iowa State University, United States

                Reviewed by: Ramji Bogati, Nepal Open University, Nepal; R. Bryan Ormond, North Carolina State University, United States

                *Correspondence: David J. Lee, dlee@ 123456med.miami.edu

                †These authors have contributed equally to this work

                Article
                DOI: 10.3389/fonc.2023.1130754
                PMC ID: 10213433
                SO-VID: 9f9d6f21-e34b-4900-9179-a14de4e2c976
                Copyright © Copyright © 2023 Lee, Ahn, McClure, Caban-Martinez, Kobetz, Ukani, Boga, Hernandez and Pinheiro
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 10 January 2023
                Date accepted : 26 April 2023
                Page count
                Figures: 5, Tables: 2, Equations: 0, References: 68, Pages: 13, Words: 7309
                Funding
                Funded by: National Institutes of Health , doi 10.13039/100000002;
                Award ID: P30CA240139.
                This study was supported by funds from Florida State Appropriation #2382A ( https://umiamihealth.org/sylvester-comprehensive-cancer-center/research/firefighter-cancer-initiative). Research reported in this publication was also supported by the National Cancer Institute of the National Institutes of Health under Award Number P30CA240139. The funder had no role in the developing the protocol for the study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The data used in this report were collected by The Florida State Fire Marshal’s Office and the Florida Cancer Data System (FCDS), the statewide cancer registry funded by the Florida Department of Health (DOH), and the Centers for Disease Control and Prevention’s National Program of Cancer Registries (CDC‐NPCR).
                Categories
                Subject: Oncology
                Subject: Original Research
                Custom metadata
                section-in-acceptance Cancer Epidemiology and Prevention

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: firefighters,meta-analysis,cancer incidence,cancer mortality,occupational research,review
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: firefighters, meta-analysis, cancer incidence, cancer mortality, occupational research, review

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