Firefighters and Cancer: A Review of the Current State of Cancer Incidences and Recent Trends in Risk Perception and Risk Reduction Efforts
Main Article Content
Abstract
Objective: This paper provides a review of current knowledge and trends in research on firefighters cancer risks and risk reduction efforts and calls for future research focused on European and international firefighters to understand and reduce occupational cancer risk.
Cancer incidence: Firefighters face increased occupational cancer risk. Firefighting has been linked with multiple types of cancer, including bladder, colorectal, brain and central nervous system, non-Hodgkin’s lymphoma, skin melanoma, and prostate and testicular cancer, with several others types of cancer being found at increased rates.
Cancer risks: Increased occupational cancer risk is, in part, related to carcinogenic exposures at fire events and improper use and cleaning of personal protective equipment (PPE), with role and years in service increasing risk.
Risk Perception: Research on efforts to reduce cancer risk are growing, and include examination of firefighter knowledge, attitudes, norms, and behaviors toward decontamination, screening, and healthy eating. Many firefighters report high perceived susceptibility and severity of cancer risk, and identify fire scene exposures, contaminated gear, diet, sleep disruption, chemical exposure from cleaning products, and barriers to medical care as contributing to increased risk.
Risk Reduction: Firefighters have strong desire to reduce cancer risk and report generally favorable attitudes toward decontamination practices and proper gear use, but face barriers to reducing those risks, including lack of knowledge, occupational needs, organizational culture, policy, and lack of resources. Behavioral interventions to reduce cancer risk through decontamination efforts and dietary change have demonstrated positive results, however there is a dearth of research on these efforts, especially with European and international firefighters.
Future Directions: Future research should focus on understanding European and international firefighters’ knowledge, attitudes, and behaviors toward cancer risk reduction, the impact of the built environment on cancer risk (station layout, clean cabs), improved efforts at tracking exposures, use of new technology and virtual reality in training to reduce cancer risk, and improved understanding of firefighter cancer risk by medical professionals.
Keywords:
Firefighters, Cancer, Risk Perception, Risk Reduction, Decontamination
Article Details
How to Cite
HARRISON, Tyler R.; MUHAMAD, Jessica Wendorf; MALOVA, Ekaterina.
Firefighters and Cancer: A Review of the Current State of Cancer Incidences and Recent Trends in Risk Perception and Risk Reduction Efforts.
Medical Research Archives, [S.l.], v. 10, n. 11, nov. 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3320>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v10i11.3320.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Demers PA, DeMarini DM, Fent KW, et al. Carcinogenicity of occupational exposure as a firefighter. The Lancet Oncology. 2022;23(8):985-986. Doi:10.1016/s1470-2045(22)00390-4
2. Lee DJ, Koru‐Sengul T, Hernandez MN, et al. Cancer risk among career male and female florida firefighters: Evidence from the Florida Firefighter Cancer Registry (1981‐2014). Am J Ind Med. 2020;63(4):285-299. Doi:10.1002/ajim.23086
3. Butry DT, Webb D, Gilbert S, Taylor J. The economics of firefighter injuries in the United States. 2019. Doi:10.6028/nist.tn.2078
4. Soteriades ES, Kim J, Christophi CA, Kales SN. Cancer incidence and mortality in firefighters: A state-of-the-art review and meta-َanalysis. Asian Pac J Cancer Prev. 2019;20(11):3221-3231. Doi:10.31557/apjcp.2019.20.11.3221
5. Jalilian H, Ziaei M, Weiderpass E, Rueegg CS, Khosravi Y, Kjaerheim K. Author’s reply to: Cancer incidence and mortality among firefighters. Int J Cancer. 2019. Doi:10.1002/ijc.32300
6. Dolin PJ, Cook-Mozaffari P. Occupation and bladder cancer: A death-certificate study. Br J Cancer. 1992;66(3):568-578. Doi:10.1038/bjc.1992.316
7. Daniels RD, Bertke S, Dahm MM, et al. Exposure–response relationships for select cancer and non-cancer health outcomes in a cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950–2009). Occup Envir Med. 2015;72(10):699-706. Doi:10.1136/oemed-2014-102671
8. Walsh JM, Potter MB, Arora M, Gildegorin G, Terdiman J. A workplace colorectal cancer screening program in Firefighters: Lessons Learned. Occup Med. 2014;64(4):255-258. Doi:10.1093/occmed/kqu046
9. Maloney SR, Udasin IG, Black TM, et al. Perceived health risks among firefighters; the New Jersey Firefighter Health Survey. J Occup Envir Med. 2020;63(4):317-321. Doi:10.1097/jom.0000000000002125
10. Oh HE, Kim SJ, Woo H, Ham S. Associations between awareness of the risk of exposure to pollutants occurring at fire scenes and health beliefs among metropolitan firefighters in the Republic of Korea. Int J Environ Res Public Health. 2022;19(14):8860. Doi:10.3390/ijerph19148860
11. Laroche E, L’Espérance S. Cancer incidence and mortality among firefighters: An overview of Epidemiologic Systematic Reviews. Int J Environ Res Public Health. 2021;18(5):2519. doi:10.3390/ijerph18052519
12. Harris MA, Kirkham TL, MacLeod JS, Tjepkema M, Peters PA, Demers PA. Surveillance of cancer risks for firefighters, police, and armed forces among men in a Canadian census cohort. Am J Ind Med. 2018;61(10):815-823. doi:10.1002/ajim.22891
13. Casjens S, Brüning T, Taeger D. Cancer risks of firefighters: A systematic review and meta-analysis of secular trends and region-specific differences. Int Arch Occup Environ Health. 2020;93(7):839-852. doi:10.1007/s00420-020-01539-0
14. Lee DJ, Koru‐Sengul T, Hernandez MN, et al. Cancer risk among career male and female florida firefighters: Evidence from the Florida Firefighter Cancer Registry (1981‐2014). Am J Ind Med. 2020;63(4):285-299. doi:10.1002/ajim.23086
15. Jung AM, Zhou J, Beitel SC, et al. Longitudinal evaluation of whole blood MIRNA expression in firefighters. J Expos Sci Environ Epi. 2021;31(5):900-912. doi:10.1038/s41370-021-00306-8
16. Muegge CM, Zollinger TW, Song Y, Wessel J, Monahan PO, Moffatt SM. Excess mortality among Indiana Firefighters, 1985-2013. Am J Ind Med. 2018;61(12):961-967. doi:10.1002/ajim.22918
17. Landgren O, Zeig-Owens R, Giricz O, et al. Multiple myeloma and its precursor disease among firefighters exposed to the World Trade Center disaster. JAMA Oncology. 2018;4(6):821. doi:10.1001/jamaoncol.2018.0509
18. Georgakopoulou R, Fiste O, Sergentanis TN, et al. Occupational exposure and multiple myeloma risk: An updated review of Meta-Analyses. J Clin Med. 2021;10(18):4179. doi:10.3390/jcm10184179
19. Gallagher A. Potential toxic mechanisms for increased cancer risks in firefighters. Oncol Times. 2022;44(18):17-18. doi:10.1097/01.cot.0000884692.76827.a1
20. Hwang J, Xu C, Agnew RJ, Clifton S, Malone TR. Health risks of structural firefighters from exposure to polycyclic aromatic hydrocarbons: A systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18(8):4209. doi:10.3390/ijerph18084209
21. Barros B, Oliveira M, Morais S. Firefighters’ occupational exposure: Contribution from biomarkers of effect to assess health risks. Environ Int. 2021;156:106704. doi:10.1016/j.envint.2021.106704
22. Korn GP, Alvarenga EH, Dall'Oglio GP, et al. The effects in the upper airway of heat and exposure to combustion byproducts of burning materials on larynx of firefighters. J Voice. 2022;36(5). doi:10.1016/j.jvoice.2020.08.020
23. Andersen MH, Saber AT, Clausen PA, et al. Association between polycyclic aromatic hydrocarbon exposure and peripheral blood mononuclear cell DNA damage in human volunteers during fire extinction exercises. Mutagenesis. 2017;33(1):105-115. doi:10.1093/mutage/gex021
24. Goodrich JM, Furlong MA, Caban-Martinez AJ, et al. Differential DNA methylation by Hispanic ethnicity among firefighters in the United States. Epigenet Insights. 2021;14:251686572110061. doi:10.1177/25168657211006159
25. Smith DL, Friedman NMG, Bloom SI, et al. Firefighting induces acute inflammatory responses that are not relieved by aspirin in older firefighters. J Occup Environ Med. 2019;61(7):617-622. doi:10.1097/jom.0000000000001626
26. McAllister MJ, Gonzalez AE, Waldman HS. Time restricted feeding reduces inflammation and cortisol response to a firegrounds test in professional firefighters. J Occup Environ Med. 2021;63(5):441-447. doi:10.1097/jom.0000000000002169
27. Gaughan DM, Cox-Ganser JM, Enright PL, et al. Acute upper and lower respiratory effects in wildland firefighters. J Occup Environ Med. 2008;50(9):1019-1028. doi:10.1097/jom.0b013e3181754161
28. Brinchmann BC, Bugge MD, Nordby K-C, Alfonso JH. Firefighting and melanoma, epidemiological and toxicological associations: A case report. Occup Med. 2022;72(2):142-144. doi:10.1093/occmed/kqab183
29. Oliveira M, Slezakova K, Fernandes A, et al. Occupational exposure of firefighters to polycyclic aromatic hydrocarbons in non-fire work environments. Sci Total Environ. 2017;592:277-287. doi:10.1016/j.scitotenv.2017.03.081
30. Slezakova K, Esteves F, Vaz J, et al. Occupational exposure of firefighters in non-fire settings. Studies in Systems, Decision and Control. 2022:79-88. doi:10.1007/978-3-031-12547-8_7
31. Webber MP, Singh A, Zeig-Owens R, et al. Cancer incidence in World Trade Center-exposed and non-exposed male firefighters, as compared with the US adult male population: 2001–2016. Occup Environ Med. 2021;78(10):707-714. doi:10.1136/oemed-2021-107570
32. Fent KW, Mayer AC, Toennis C, et al. Firefighters’ urinary concentrations of VOC metabolites after controlled-residential and Training fire responses. Int J Hyg Environ Health. 2022;242:113969. doi:10.1016/j.ijheh.2022.113969
33. Peaslee GF, Wilkinson JT, McGuinness SR, et al. Another pathway for firefighter exposure to per- and polyfluoroalkyl substances: Firefighter textiles. Environmental Science & Technology Letters. 2020;7(8):594-599. doi:10.1021/acs.estlett.0c00410
34. Bott RC, Kirk KM, Logan MB, Reid DA. Diesel particulate matter and polycyclic aromatic hydrocarbons in fire stations. Environ Sci Processes & Impacts. 2017;19(10):1320-1326. doi:10.1039/c7em00291b
35. Clarity C, Trowbridge J, Gerona R, et al. Associations between polyfluoroalkyl substance and organophosphate flame retardant exposures and telomere length in a cohort of women firefighters and office workers in San Francisco. Environ Health. 2021;20(1). doi:10.1186/s12940-021-00778-z
36. Yu P, Xu R, Li S, et al. Exposure to wildfire-related PM2.5 and site-specific cancer mortality in Brazil from 2010 to 2016: A retrospective study. PLOS Medicine. 2022;19(9). doi:10.1371/journal.pmed.1004103
37. Langevin SM, Eliot M, Butler RA, McClean M, Kelsey KT. Firefighter occupation is associated with increased risk for laryngeal and hypopharyngeal squamous cell carcinoma among men from the Greater Boston area. Occup Environ Med. 2020;77(6):381-385. doi:10.1136/oemed-2019-106271
38. Zhao G, Erazo B, Ronda E, Brocal F, Regidor E. Mortality among firefighters in Spain: 10 years of follow-up. Ann Work Expo Health. 2020;64(6):614-621. doi:10.1093/annweh/wxaa036
39. Jahnke SA, Poston WS, Jitnarin N, Haddock CK. Health concerns of the U.S. Fire Service: Perspectives from the Firehouse. Am J Health Promot. 2012;27(2):111-118. doi:10.4278/ajhp.110311-qual-109
40. Schaefer Solle N, Caban-Martinez AJ, Levy RA, et al. Perceptions of health and cancer risk among newly recruited firefighters in South Florida. Am J Ind Med. 2017;61(1):77-84. doi:10.1002/ajim.22785
41. Solle NS, Santiago KM, Louzado Feliciano P, et al. Perceptions of work-related health and cancer risks among women firefighters. J Occup Enviro Med. 2021;63(12). doi:10.1097/jom.0000000000002386
42. Anderson DA, Harrison TR, Yang F, Wendorf Muhamad J, Morgan SE. Firefighter perceptions of cancer risk: Results of a qualitative study. Am J Ind Med. 2017;60(7):644-650. doi:10.1002/ajim.22726
43. Jitnarin N, Poston WSC, Jahnke SA, Haddock CK, Kelley HN. Cancer perceptions among smokeless tobacco users: A qualitative study of US firefighters. Saf Health Work. 2020;11(3):284-290. doi:10.1016/j.shaw.2020.04.004
44. Macy GB, Hwang J, Taylor R, Golla V, Cann C, Gates B. Examining behaviors related to retirement, cleaning, and storage of turnout gear among rural firefighters. Workplace Health Saf. 2019;68(3):129-138. doi:10.1177/2165079919882951
45. Louzado-Feliciano P, Santiago KM, Paule L, et al. Perceptions of occupational cancer risk and prevention among Dominican Republic Firefighters. J Occup Enviro Med. 2021;64(3). doi:10.1097/jom.0000000000002466
46. Bautista M, Jr. Emergency Responders' Perceptions of Environmental Health Hazards and Personal Protection in Responses. [Dissertation]. Capella University; 2020.
47. Popescu C. 363 Fire Department Cancer Risk Exposure Reduction Project. Ann Emerg Med. 2021;78(4). doi:10.1016/j.annemergmed.2021.09.378
48. Harrison TR, Yang F, Anderson D, et al. Resilience, culture change, and cancer risk reduction in a fire rescue organization: Clean Gear as the new badge of honor. Journal of Contingencies and Crisis Management. 2017;25(3):171-181. doi:10.1111/1468-5973.12182
49. Harrison TR, Muhamad JW, Yang F, et al. Firefighter attitudes, norms, beliefs, barriers, and behaviors toward post-fire decontamination processes in an era of increased cancer risk. J Occup Enviro Hyg. 2018;15(4):279-284. doi:10.1080/15459624.2017.1416389
50. Moore KJ, Koru-Sengul T, Alvarez A, et al. Safety gear decontamination practices among Florida firefighters: Analysis of a text-based survey methodology. Workplace Health Saf. 2018;66(11): 522-529. doi:10.1177/2165079918754331
51. Harrison TR, Yang F, Morgan SE, Wendorf Muhamad J, Talavera E, Eaton SA, Niemczyk N, Sheppard V, Kobetz E. The invisible danger of transferring toxins with bunker gear: a theory-based intervention to increase postfire decontamination to reduce cancer risk in firefighters. J Health Comm. 2018; 23(12):999-1007. doi:10.1080/10810730.2018.1535633
52. Solle NS, Harte L, Allam N, et al. Attitudes and Perceptions of Cervical Cancer Screening in Female Firefighters: Evidence from the Florida Firefighter Cancer Initiative. APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016). APHA
53. Park HS, Ham S, Jeong JH, Kim SJ, Woo H. Examination of Factors Influencing SCBA Washing Behavior among Firefighters in Metropolitan. Int J Environ Res Public Health. 2022;19(4):2240. doi:10.3390/ijerph19042240
54. Moura, F.D.D., Descontaminação grossa pós intervenção em atmosferas imediatamente perigosas à vida e à saúde: uma análise dos procedimentos atualmente exequíveis às guarnições de serviço. Monograph. Centro de Estudos de Política, Estratégia e Doutrina, Brasil; 2021. https://biblioteca.cbm.df.gov.br/jspui/bitstream/123456789/190/1/TCC%20CAO%20-%20Cap.%20Fernando%20%20-%20versao%20entrega.pdf. Accessed September 21, 2022.
55. Ogunsina K, Solle N, Murphy LA, et al. Abstract PO-251: Examining facilitators and barriers to cancer screening among Black firefighters in South Florida. Cancer Epidemiol Biomarkers Prev. 2020;(12_Supplement):PO-251. doi:10.1158/1538-7755.DISP20-PO-251
56. Burgess JL, Hoppe-Jones C, Griffin SC, et al. Evaluation of Interventions to Reduce Firefighter Exposures. J Occup Environ Med. 2020;62(4):279-288. doi:10.1097/JOM.0000000000001815
57. Fent KW, Alexander B, Roberts J, et al. Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures. J Occup Environ Hyg. 2017;14(10):801-814. doi:10.1080/15459624.2017.1334904
58. Abrard S, Bertrand M, De Valence T, Schaupp T. French firefighters exposure to Benzo[a]pyrene after simulated structure fires. Int J Hyg Environ Health. 2019;222(1): 84-88. doi: 10.1016/j.ijheh.2018.08.010
59. Harrison TR. Enhancing Communication Interventions and Evaluations through Communication Design. J Appl Commun Res. 2014;42(2):135-149. doi:10.1080/00909882.2013.825047
60. Harrison TR, Williams EA, Reynolds AR. The intersections of organizations, health, and safety. The Handbook of Applied Communication Research. Published online April 17, 2020:279-296. doi:10.1002/9781119399926.ch17
61. Yzer M. Perceived Behavioral Control in Reasoned Action Theory: A Dual-Aspect Interpretation. Ann Am Acad Pol Soc Sci. 2012;640(1):101-117. doi:10.1177/0002716211423500
62. Rosenstock IM. The Health Belief Model and Preventive Health Behavior. Health Educ Monogr. 1974;2(4):354-386. doi:10.1177/109019817400200405
63. Frattaroli S, Pollack KM, Bailey M, Schafer H, Cheskin LJ, Holtgrave DR. Working inside the firehouse: developing a participant-driven intervention to enhance health-promoting behaviors. Health Promot Pract. 2013;14(3):451-458. doi:10.1177/1524839912461150
64. Elliot DL, Goldberg L, Kuehl KS, Moe EL, Breger RKR, Pickering MA. The PHLAME (Promoting Healthy Lifestyles: Alternative Models’ Effects) firefighter study: outcomes of two models of behavior change. J Occup Environ Med. 2007;49(2):204-213. doi:10.1097/JOM.0b013e3180329a8d
65. Chewning L, Doerfel M, Ballard D, Harrison TR. From crisis response to high resilience organizing. Miller V, Poole MS, eds. Handbook of Organizational Communication. Walter de Gruyter. (in press)
66. Zanatta M, Amaral FG. Production layout improvement in emergency services: a participatory approach. Work. 2012;41 Suppl 1:1720-1726. doi:10.3233/WOR-2012-0375-1720
67. Maglio MA, Scott C, Davis AL, Allen J, Taylor JA. Situational Pressures that Influence Firefighters’ Decision Making about Personal Protective Equipment: A Qualitative Analysis. Am J Health Behav. 2016;40(5):555-567. doi:10.5993/AJHB.40.5.2
68. Firefighter Cancer Support Network. Taking action against cancer in the fire service. 2013. Retrieved from https://firefightercancersupport.org/taking-action-against-cancer-in-the-fire-service/
69. Horn GP, Fent KW, Kerber S, Smith DL. Hierarchy of contamination control in the fire service: Review of exposure control options to reduce cancer risk. J Occup Environ Hyg. 2022; 28:1-20.
70. Bator CH. Collaborating for Firefighter Safety and Health. Fire Engineering. 2018;171(6):37-40.
71. Millet B. Designing an Occupational Exposure Report for Aircraft Rescue and Firefighting. Proc Hum Factors Ergon Soc Ann Meet. 2020; 64(1): 924–927. doi:10.1177/1071181320641220
72. Millet B. Integrating User-Centered Design Into the Sylvester Firefighter Cancer Initiative’s Personal Exposure Reporter. Ergon Des. 2021; 9:10648046211051196.
73. Baile WF, Aaron J. Patient-physician communication in oncology: past, present, and future. Curr Opin Oncol. 2005;17(4):331-335. doi:10.1097/01.cco.0000167738.49325.2c
74. Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10(1):38-43.
75. Ogunsina K, Solle N, Murphy LA, et al. Abstract PO-251: Examining facilitators and barriers to cancer screening among Black firefighters in South Florida. Cancer Epidemiol Biomarkers Prev. 2020;(12_Supplement):PO-251. doi:10.1158/1538-7755.DISP20-PO-251
76. Lubberding S, van Uden-Kraan CF, Te Velde EA, Cuijpers P, Leemans CR, Verdonck-de Leeuw IM. Improving access to supportive cancer care through an eHealth application: a qualitative needs assessment among cancer survivors. J Clin Nurs. 2015;24(9-10):1367-1379. doi:10.1111/jocn.12753
77. Donovan JL, Blake DR. Patient non-compliance: deviance or reasoned decision-making? Soc Sci Med. 1992;34(5):507-513. doi:10.1016/0277-9536(92)90206-6
78. Varvel SJ, He Y, Shannon JK, et al. Multidimensional, threshold effects of social support in firefighters: Is more support invariably better? J Couns Psychol. 2007;54(4):458-465. doi:10.1037/0022-0167.54.4.458
79. Nowicki T, Koszela J, Matuszelański Ł. Virtual reality environment to study the ergonomic features of firefighters’ activity. MATEC Web Conf. 2018;210:02050. doi:10.1051/matecconf/201821002050
80. Bellemans M, Lamrnens D, De Sloover J, et al. Training Firefighters in Virtual Reality. In: 2020 International Conference on 3D Immersion (IC3D). ieeexplore.ieee.org; 2020:01-06. doi:10.1109/IC3D51119.2020.9376336
2. Lee DJ, Koru‐Sengul T, Hernandez MN, et al. Cancer risk among career male and female florida firefighters: Evidence from the Florida Firefighter Cancer Registry (1981‐2014). Am J Ind Med. 2020;63(4):285-299. Doi:10.1002/ajim.23086
3. Butry DT, Webb D, Gilbert S, Taylor J. The economics of firefighter injuries in the United States. 2019. Doi:10.6028/nist.tn.2078
4. Soteriades ES, Kim J, Christophi CA, Kales SN. Cancer incidence and mortality in firefighters: A state-of-the-art review and meta-َanalysis. Asian Pac J Cancer Prev. 2019;20(11):3221-3231. Doi:10.31557/apjcp.2019.20.11.3221
5. Jalilian H, Ziaei M, Weiderpass E, Rueegg CS, Khosravi Y, Kjaerheim K. Author’s reply to: Cancer incidence and mortality among firefighters. Int J Cancer. 2019. Doi:10.1002/ijc.32300
6. Dolin PJ, Cook-Mozaffari P. Occupation and bladder cancer: A death-certificate study. Br J Cancer. 1992;66(3):568-578. Doi:10.1038/bjc.1992.316
7. Daniels RD, Bertke S, Dahm MM, et al. Exposure–response relationships for select cancer and non-cancer health outcomes in a cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950–2009). Occup Envir Med. 2015;72(10):699-706. Doi:10.1136/oemed-2014-102671
8. Walsh JM, Potter MB, Arora M, Gildegorin G, Terdiman J. A workplace colorectal cancer screening program in Firefighters: Lessons Learned. Occup Med. 2014;64(4):255-258. Doi:10.1093/occmed/kqu046
9. Maloney SR, Udasin IG, Black TM, et al. Perceived health risks among firefighters; the New Jersey Firefighter Health Survey. J Occup Envir Med. 2020;63(4):317-321. Doi:10.1097/jom.0000000000002125
10. Oh HE, Kim SJ, Woo H, Ham S. Associations between awareness of the risk of exposure to pollutants occurring at fire scenes and health beliefs among metropolitan firefighters in the Republic of Korea. Int J Environ Res Public Health. 2022;19(14):8860. Doi:10.3390/ijerph19148860
11. Laroche E, L’Espérance S. Cancer incidence and mortality among firefighters: An overview of Epidemiologic Systematic Reviews. Int J Environ Res Public Health. 2021;18(5):2519. doi:10.3390/ijerph18052519
12. Harris MA, Kirkham TL, MacLeod JS, Tjepkema M, Peters PA, Demers PA. Surveillance of cancer risks for firefighters, police, and armed forces among men in a Canadian census cohort. Am J Ind Med. 2018;61(10):815-823. doi:10.1002/ajim.22891
13. Casjens S, Brüning T, Taeger D. Cancer risks of firefighters: A systematic review and meta-analysis of secular trends and region-specific differences. Int Arch Occup Environ Health. 2020;93(7):839-852. doi:10.1007/s00420-020-01539-0
14. Lee DJ, Koru‐Sengul T, Hernandez MN, et al. Cancer risk among career male and female florida firefighters: Evidence from the Florida Firefighter Cancer Registry (1981‐2014). Am J Ind Med. 2020;63(4):285-299. doi:10.1002/ajim.23086
15. Jung AM, Zhou J, Beitel SC, et al. Longitudinal evaluation of whole blood MIRNA expression in firefighters. J Expos Sci Environ Epi. 2021;31(5):900-912. doi:10.1038/s41370-021-00306-8
16. Muegge CM, Zollinger TW, Song Y, Wessel J, Monahan PO, Moffatt SM. Excess mortality among Indiana Firefighters, 1985-2013. Am J Ind Med. 2018;61(12):961-967. doi:10.1002/ajim.22918
17. Landgren O, Zeig-Owens R, Giricz O, et al. Multiple myeloma and its precursor disease among firefighters exposed to the World Trade Center disaster. JAMA Oncology. 2018;4(6):821. doi:10.1001/jamaoncol.2018.0509
18. Georgakopoulou R, Fiste O, Sergentanis TN, et al. Occupational exposure and multiple myeloma risk: An updated review of Meta-Analyses. J Clin Med. 2021;10(18):4179. doi:10.3390/jcm10184179
19. Gallagher A. Potential toxic mechanisms for increased cancer risks in firefighters. Oncol Times. 2022;44(18):17-18. doi:10.1097/01.cot.0000884692.76827.a1
20. Hwang J, Xu C, Agnew RJ, Clifton S, Malone TR. Health risks of structural firefighters from exposure to polycyclic aromatic hydrocarbons: A systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18(8):4209. doi:10.3390/ijerph18084209
21. Barros B, Oliveira M, Morais S. Firefighters’ occupational exposure: Contribution from biomarkers of effect to assess health risks. Environ Int. 2021;156:106704. doi:10.1016/j.envint.2021.106704
22. Korn GP, Alvarenga EH, Dall'Oglio GP, et al. The effects in the upper airway of heat and exposure to combustion byproducts of burning materials on larynx of firefighters. J Voice. 2022;36(5). doi:10.1016/j.jvoice.2020.08.020
23. Andersen MH, Saber AT, Clausen PA, et al. Association between polycyclic aromatic hydrocarbon exposure and peripheral blood mononuclear cell DNA damage in human volunteers during fire extinction exercises. Mutagenesis. 2017;33(1):105-115. doi:10.1093/mutage/gex021
24. Goodrich JM, Furlong MA, Caban-Martinez AJ, et al. Differential DNA methylation by Hispanic ethnicity among firefighters in the United States. Epigenet Insights. 2021;14:251686572110061. doi:10.1177/25168657211006159
25. Smith DL, Friedman NMG, Bloom SI, et al. Firefighting induces acute inflammatory responses that are not relieved by aspirin in older firefighters. J Occup Environ Med. 2019;61(7):617-622. doi:10.1097/jom.0000000000001626
26. McAllister MJ, Gonzalez AE, Waldman HS. Time restricted feeding reduces inflammation and cortisol response to a firegrounds test in professional firefighters. J Occup Environ Med. 2021;63(5):441-447. doi:10.1097/jom.0000000000002169
27. Gaughan DM, Cox-Ganser JM, Enright PL, et al. Acute upper and lower respiratory effects in wildland firefighters. J Occup Environ Med. 2008;50(9):1019-1028. doi:10.1097/jom.0b013e3181754161
28. Brinchmann BC, Bugge MD, Nordby K-C, Alfonso JH. Firefighting and melanoma, epidemiological and toxicological associations: A case report. Occup Med. 2022;72(2):142-144. doi:10.1093/occmed/kqab183
29. Oliveira M, Slezakova K, Fernandes A, et al. Occupational exposure of firefighters to polycyclic aromatic hydrocarbons in non-fire work environments. Sci Total Environ. 2017;592:277-287. doi:10.1016/j.scitotenv.2017.03.081
30. Slezakova K, Esteves F, Vaz J, et al. Occupational exposure of firefighters in non-fire settings. Studies in Systems, Decision and Control. 2022:79-88. doi:10.1007/978-3-031-12547-8_7
31. Webber MP, Singh A, Zeig-Owens R, et al. Cancer incidence in World Trade Center-exposed and non-exposed male firefighters, as compared with the US adult male population: 2001–2016. Occup Environ Med. 2021;78(10):707-714. doi:10.1136/oemed-2021-107570
32. Fent KW, Mayer AC, Toennis C, et al. Firefighters’ urinary concentrations of VOC metabolites after controlled-residential and Training fire responses. Int J Hyg Environ Health. 2022;242:113969. doi:10.1016/j.ijheh.2022.113969
33. Peaslee GF, Wilkinson JT, McGuinness SR, et al. Another pathway for firefighter exposure to per- and polyfluoroalkyl substances: Firefighter textiles. Environmental Science & Technology Letters. 2020;7(8):594-599. doi:10.1021/acs.estlett.0c00410
34. Bott RC, Kirk KM, Logan MB, Reid DA. Diesel particulate matter and polycyclic aromatic hydrocarbons in fire stations. Environ Sci Processes & Impacts. 2017;19(10):1320-1326. doi:10.1039/c7em00291b
35. Clarity C, Trowbridge J, Gerona R, et al. Associations between polyfluoroalkyl substance and organophosphate flame retardant exposures and telomere length in a cohort of women firefighters and office workers in San Francisco. Environ Health. 2021;20(1). doi:10.1186/s12940-021-00778-z
36. Yu P, Xu R, Li S, et al. Exposure to wildfire-related PM2.5 and site-specific cancer mortality in Brazil from 2010 to 2016: A retrospective study. PLOS Medicine. 2022;19(9). doi:10.1371/journal.pmed.1004103
37. Langevin SM, Eliot M, Butler RA, McClean M, Kelsey KT. Firefighter occupation is associated with increased risk for laryngeal and hypopharyngeal squamous cell carcinoma among men from the Greater Boston area. Occup Environ Med. 2020;77(6):381-385. doi:10.1136/oemed-2019-106271
38. Zhao G, Erazo B, Ronda E, Brocal F, Regidor E. Mortality among firefighters in Spain: 10 years of follow-up. Ann Work Expo Health. 2020;64(6):614-621. doi:10.1093/annweh/wxaa036
39. Jahnke SA, Poston WS, Jitnarin N, Haddock CK. Health concerns of the U.S. Fire Service: Perspectives from the Firehouse. Am J Health Promot. 2012;27(2):111-118. doi:10.4278/ajhp.110311-qual-109
40. Schaefer Solle N, Caban-Martinez AJ, Levy RA, et al. Perceptions of health and cancer risk among newly recruited firefighters in South Florida. Am J Ind Med. 2017;61(1):77-84. doi:10.1002/ajim.22785
41. Solle NS, Santiago KM, Louzado Feliciano P, et al. Perceptions of work-related health and cancer risks among women firefighters. J Occup Enviro Med. 2021;63(12). doi:10.1097/jom.0000000000002386
42. Anderson DA, Harrison TR, Yang F, Wendorf Muhamad J, Morgan SE. Firefighter perceptions of cancer risk: Results of a qualitative study. Am J Ind Med. 2017;60(7):644-650. doi:10.1002/ajim.22726
43. Jitnarin N, Poston WSC, Jahnke SA, Haddock CK, Kelley HN. Cancer perceptions among smokeless tobacco users: A qualitative study of US firefighters. Saf Health Work. 2020;11(3):284-290. doi:10.1016/j.shaw.2020.04.004
44. Macy GB, Hwang J, Taylor R, Golla V, Cann C, Gates B. Examining behaviors related to retirement, cleaning, and storage of turnout gear among rural firefighters. Workplace Health Saf. 2019;68(3):129-138. doi:10.1177/2165079919882951
45. Louzado-Feliciano P, Santiago KM, Paule L, et al. Perceptions of occupational cancer risk and prevention among Dominican Republic Firefighters. J Occup Enviro Med. 2021;64(3). doi:10.1097/jom.0000000000002466
46. Bautista M, Jr. Emergency Responders' Perceptions of Environmental Health Hazards and Personal Protection in Responses. [Dissertation]. Capella University; 2020.
47. Popescu C. 363 Fire Department Cancer Risk Exposure Reduction Project. Ann Emerg Med. 2021;78(4). doi:10.1016/j.annemergmed.2021.09.378
48. Harrison TR, Yang F, Anderson D, et al. Resilience, culture change, and cancer risk reduction in a fire rescue organization: Clean Gear as the new badge of honor. Journal of Contingencies and Crisis Management. 2017;25(3):171-181. doi:10.1111/1468-5973.12182
49. Harrison TR, Muhamad JW, Yang F, et al. Firefighter attitudes, norms, beliefs, barriers, and behaviors toward post-fire decontamination processes in an era of increased cancer risk. J Occup Enviro Hyg. 2018;15(4):279-284. doi:10.1080/15459624.2017.1416389
50. Moore KJ, Koru-Sengul T, Alvarez A, et al. Safety gear decontamination practices among Florida firefighters: Analysis of a text-based survey methodology. Workplace Health Saf. 2018;66(11): 522-529. doi:10.1177/2165079918754331
51. Harrison TR, Yang F, Morgan SE, Wendorf Muhamad J, Talavera E, Eaton SA, Niemczyk N, Sheppard V, Kobetz E. The invisible danger of transferring toxins with bunker gear: a theory-based intervention to increase postfire decontamination to reduce cancer risk in firefighters. J Health Comm. 2018; 23(12):999-1007. doi:10.1080/10810730.2018.1535633
52. Solle NS, Harte L, Allam N, et al. Attitudes and Perceptions of Cervical Cancer Screening in Female Firefighters: Evidence from the Florida Firefighter Cancer Initiative. APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016). APHA
53. Park HS, Ham S, Jeong JH, Kim SJ, Woo H. Examination of Factors Influencing SCBA Washing Behavior among Firefighters in Metropolitan. Int J Environ Res Public Health. 2022;19(4):2240. doi:10.3390/ijerph19042240
54. Moura, F.D.D., Descontaminação grossa pós intervenção em atmosferas imediatamente perigosas à vida e à saúde: uma análise dos procedimentos atualmente exequíveis às guarnições de serviço. Monograph. Centro de Estudos de Política, Estratégia e Doutrina, Brasil; 2021. https://biblioteca.cbm.df.gov.br/jspui/bitstream/123456789/190/1/TCC%20CAO%20-%20Cap.%20Fernando%20%20-%20versao%20entrega.pdf. Accessed September 21, 2022.
55. Ogunsina K, Solle N, Murphy LA, et al. Abstract PO-251: Examining facilitators and barriers to cancer screening among Black firefighters in South Florida. Cancer Epidemiol Biomarkers Prev. 2020;(12_Supplement):PO-251. doi:10.1158/1538-7755.DISP20-PO-251
56. Burgess JL, Hoppe-Jones C, Griffin SC, et al. Evaluation of Interventions to Reduce Firefighter Exposures. J Occup Environ Med. 2020;62(4):279-288. doi:10.1097/JOM.0000000000001815
57. Fent KW, Alexander B, Roberts J, et al. Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures. J Occup Environ Hyg. 2017;14(10):801-814. doi:10.1080/15459624.2017.1334904
58. Abrard S, Bertrand M, De Valence T, Schaupp T. French firefighters exposure to Benzo[a]pyrene after simulated structure fires. Int J Hyg Environ Health. 2019;222(1): 84-88. doi: 10.1016/j.ijheh.2018.08.010
59. Harrison TR. Enhancing Communication Interventions and Evaluations through Communication Design. J Appl Commun Res. 2014;42(2):135-149. doi:10.1080/00909882.2013.825047
60. Harrison TR, Williams EA, Reynolds AR. The intersections of organizations, health, and safety. The Handbook of Applied Communication Research. Published online April 17, 2020:279-296. doi:10.1002/9781119399926.ch17
61. Yzer M. Perceived Behavioral Control in Reasoned Action Theory: A Dual-Aspect Interpretation. Ann Am Acad Pol Soc Sci. 2012;640(1):101-117. doi:10.1177/0002716211423500
62. Rosenstock IM. The Health Belief Model and Preventive Health Behavior. Health Educ Monogr. 1974;2(4):354-386. doi:10.1177/109019817400200405
63. Frattaroli S, Pollack KM, Bailey M, Schafer H, Cheskin LJ, Holtgrave DR. Working inside the firehouse: developing a participant-driven intervention to enhance health-promoting behaviors. Health Promot Pract. 2013;14(3):451-458. doi:10.1177/1524839912461150
64. Elliot DL, Goldberg L, Kuehl KS, Moe EL, Breger RKR, Pickering MA. The PHLAME (Promoting Healthy Lifestyles: Alternative Models’ Effects) firefighter study: outcomes of two models of behavior change. J Occup Environ Med. 2007;49(2):204-213. doi:10.1097/JOM.0b013e3180329a8d
65. Chewning L, Doerfel M, Ballard D, Harrison TR. From crisis response to high resilience organizing. Miller V, Poole MS, eds. Handbook of Organizational Communication. Walter de Gruyter. (in press)
66. Zanatta M, Amaral FG. Production layout improvement in emergency services: a participatory approach. Work. 2012;41 Suppl 1:1720-1726. doi:10.3233/WOR-2012-0375-1720
67. Maglio MA, Scott C, Davis AL, Allen J, Taylor JA. Situational Pressures that Influence Firefighters’ Decision Making about Personal Protective Equipment: A Qualitative Analysis. Am J Health Behav. 2016;40(5):555-567. doi:10.5993/AJHB.40.5.2
68. Firefighter Cancer Support Network. Taking action against cancer in the fire service. 2013. Retrieved from https://firefightercancersupport.org/taking-action-against-cancer-in-the-fire-service/
69. Horn GP, Fent KW, Kerber S, Smith DL. Hierarchy of contamination control in the fire service: Review of exposure control options to reduce cancer risk. J Occup Environ Hyg. 2022; 28:1-20.
70. Bator CH. Collaborating for Firefighter Safety and Health. Fire Engineering. 2018;171(6):37-40.
71. Millet B. Designing an Occupational Exposure Report for Aircraft Rescue and Firefighting. Proc Hum Factors Ergon Soc Ann Meet. 2020; 64(1): 924–927. doi:10.1177/1071181320641220
72. Millet B. Integrating User-Centered Design Into the Sylvester Firefighter Cancer Initiative’s Personal Exposure Reporter. Ergon Des. 2021; 9:10648046211051196.
73. Baile WF, Aaron J. Patient-physician communication in oncology: past, present, and future. Curr Opin Oncol. 2005;17(4):331-335. doi:10.1097/01.cco.0000167738.49325.2c
74. Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10(1):38-43.
75. Ogunsina K, Solle N, Murphy LA, et al. Abstract PO-251: Examining facilitators and barriers to cancer screening among Black firefighters in South Florida. Cancer Epidemiol Biomarkers Prev. 2020;(12_Supplement):PO-251. doi:10.1158/1538-7755.DISP20-PO-251
76. Lubberding S, van Uden-Kraan CF, Te Velde EA, Cuijpers P, Leemans CR, Verdonck-de Leeuw IM. Improving access to supportive cancer care through an eHealth application: a qualitative needs assessment among cancer survivors. J Clin Nurs. 2015;24(9-10):1367-1379. doi:10.1111/jocn.12753
77. Donovan JL, Blake DR. Patient non-compliance: deviance or reasoned decision-making? Soc Sci Med. 1992;34(5):507-513. doi:10.1016/0277-9536(92)90206-6
78. Varvel SJ, He Y, Shannon JK, et al. Multidimensional, threshold effects of social support in firefighters: Is more support invariably better? J Couns Psychol. 2007;54(4):458-465. doi:10.1037/0022-0167.54.4.458
79. Nowicki T, Koszela J, Matuszelański Ł. Virtual reality environment to study the ergonomic features of firefighters’ activity. MATEC Web Conf. 2018;210:02050. doi:10.1051/matecconf/201821002050
80. Bellemans M, Lamrnens D, De Sloover J, et al. Training Firefighters in Virtual Reality. In: 2020 International Conference on 3D Immersion (IC3D). ieeexplore.ieee.org; 2020:01-06. doi:10.1109/IC3D51119.2020.9376336