Journal Article

Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950–2009)

Zahm, Shelia H, Yiin, James H, Hales, Thomas R, Kubale, Travis L, Daniels, Robert D, Baris, Dalsu, Beaumont, James J, Waters, Kathleen M, Pinkerton, Lynne E, Dahm, Matthew M

2014

Overview

Objectives To examine mortality patterns and cancer incidence in a pooled cohort of 29 993 US career firefighters employed since 1950 and followed through 2009. Methods Mortality and cancer incidence were evaluated by life table methods with the US population referent. Standardised mortality (SMR) and incidence (SIR) ratios were determined for 92 causes of death and 41 cancer incidence groupings. Analyses focused on 15 outcomes of a priori interest. Sensitivity analyses were conducted to examine the potential for significant bias. Results Person-years at risk totalled 858 938 and 403 152 for mortality and incidence analyses, respectively. All-cause mortality was at expectation (SMR=0.99, 95% CI 0.97 to 1.01, n=12 028). There was excess cancer mortality (SMR=1.14, 95% CI 1.10 to 1.18, n=3285) and incidence (SIR=1.09, 95% CI 1.06 to 1.12, n=4461) comprised mainly of digestive (SMR=1.26, 95% CI 1.18 to 1.34, n=928; SIR=1.17, 95% CI 1.10 to 1.25, n=930) and respiratory (SMR=1.10, 95% CI 1.04 to 1.17, n=1096; SIR=1.16, 95% CI 1.08 to 1.24, n=813) cancers. Consistent with previous reports, modest elevations were observed in several solid cancers; however, evidence of excess lymphatic or haematopoietic cancers was lacking. This study is the first to report excess malignant mesothelioma (SMR=2.00, 95% CI 1.03 to 3.49, n=12; SIR=2.29, 95% CI 1.60 to 3.19, n=35) among US firefighters. Results appeared robust under differing assumptions and analytic techniques. Conclusions Our results provide evidence of a relation between firefighting and cancer. The new finding of excess malignant mesothelioma is noteworthy, given that asbestos exposure is a known hazard of firefighting.

• Publisher: BMJ Publishing Group,BMJ Publishing Group LTD
• Subject: Adult / Aged / Asbestos / Asbestos - adverse effects / Biological and medical sciences / Brain research / Cancer / Cancer incidence / Careers / Cause of Death / Chicago - epidemiology / Chronic obstructive pulmonary disease / Cohort Studies / Death / Digestive System Neoplasms - epidemiology / Digestive System Neoplasms - etiology / Digestive System Neoplasms - mortality / Epidemiology / Female / Fire departments / Fire fighting / Fire service / Fire stations / Firefighters / Fires / Humans / Incidence / Job titles / Life tables / Lung Neoplasms - epidemiology / Lung Neoplasms - etiology / Lung Neoplasms - mortality / Male / Medical sciences / Mesothelioma / Mesothelioma - epidemiology / Mesothelioma - etiology / Mesothelioma - mortality / Mesothelioma, Malignant / Middle Aged / Mortality / Mortality patterns / Multiple myeloma / Multiple tumors. Solid tumors. Tumors in childhood (general aspects) / Neoplasms - epidemiology / Neoplasms - etiology / Occupational Diseases - epidemiology / Occupational Diseases - etiology / Occupational Diseases - mortality / Occupational Exposure - adverse effects / Occupational medicine / Philadelphia - epidemiology / Prostate / Public health. Hygiene-occupational medicine / Respiratory Tract Neoplasms - epidemiology / Respiratory Tract Neoplasms - etiology / Respiratory Tract Neoplasms - mortality / San Francisco - epidemiology / Sensitivity analysis / Social security / Testes / Tumors / Urinary bladder / White people / Workplace