Building the Case for Presumptive Cancer Legislation: We Need Your Help!

( The Volunteer Firefighter )

“There are 92,000 reasons that volunteer firefighters should have presumptive cancer coverage in New York State.” There is power in this quote from FASNY Past President Robert N. McConville in the press release announcing the 2015 FASNY-sponsored video, “Fighting Fires, Fighting Cancer.” (1)

One thing we can all agree on after watching the political conventions in this national election year is that the “power to the people” sentiment is alive and well. Can you imagine if all 92,000 volunteer firefighters in New York State – and if the almost 800,000 throughout the country – stood as one and said that now is the time to address the impact of service as a volunteer firefighter on cancer risks?

The Association between Firefighting and Cancer
It is firmly established in the occupational medicine literature that firefighters are exposed to many known and suspected human carcinogens every time they respond to a fire scene. Numerous studies have measured levels of chemical carcinogens at structural and vehicle fires – and from the personal protective clothing of firefighters – at concentrations that are considered hazardous and well in excess of permissible workplace levels. These carcinogens include polycyclic aromatic hydrocarbons (PAHs) in soot and tars; benzene; formaldehyde; 1,3-butadiene; arsenic; polychlorinated biphenyls (PCBs); dioxins; asbestos; and diesel engine exhaust.
The uncontrolled environmental conditions that occur during the knockdown and overhaul phases at fire scenes guarantee that firefighters are routinely exposed to these toxic chemicals. So, it’s not surprising that studies of cancer in career firefighters find significant associations between firefighting and certain forms of cancer. The evidence is strongest for increased risk of brain, digestive tract (colorectal, stomach), genitourinary tract (bladder, kidney, testicles, prostate), lympho-hematopoietic (leukemia, Non-
Hodgkin’s lymphoma, multiple myeloma), skin (melanoma) and lung cancers among firefighters. The presumptive cancer bills covering career firefighters were built on the results of these studies.

What about Volunteer Firefighters?
It is not only challenging to evaluate and reconcile the differing results of the dozens of studies of cancer among firefighters in the U.S. and other countries but, importantly, no studies to date have been published on the impact of cancer on volunteer firefighters.

We do have “Taking Action against Cancer in the Fire Service,” a comprehensive summary available from the Firefighter Cancer Support Network (2), which resulted from a 2013 workshop attended by volunteer, combination and career fire department representatives; researchers from the medical community; and other stakeholders. It is a landmark white paper that describes the status of cancer risks and cancer research in the fire service. In addition to summarizing the findings of existing studies, it established a clear-cut and hard-hitting, yet achievable, set of priorities for securing the data needed to get the answers that every firefighter deserves to have.

And there is a new study under way. Working with industry leaders and fire departments throughout Australia, Dr. Deborah Glass and colleagues are conducting the largest firefighter study to date which includes over 163,000 volunteers. (3) In the next few years, we’ll be hearing a great deal more about the Australian study as the results are peer-reviewed and published in the occupational medicine literature. Preliminary reports are available online and additional analyses and years of follow-up for cancer are planned.

“So what’s the problem?” you might be thinking, “Aren’t there also a couple of recent reports that everybody talks about that prove the risks of cancer are real?” In 2006, Grace LeMasters did a meta-analysis of 32 published studies of cancer in firefighters and, in 2014, Robert Daniels combined data from three large fire departments to analyze cancer occurrence and death over a 60-year period for the National Institute for Occupational Safety and Health (NIOSH) study. (4, 5)

Don’t these provide all the proof we need? Unfortunately, inconsistencies across different studies and some relatively small increases in risks seen in career firefighters are cited as reasons to undermine the importance of getting comparable data about volunteers. And the studies only directly address cancer risks in career firefighters, ignoring the largest group of firefighters in the country: the volunteer fire service.

How Does This Apply to Volunteer Firefighters in New York State?
The results of the Australian study will be extremely useful; however, will they be considered relevant for estimating the number of volunteers in the New York State fire service who will fall victim to cancers related to firefighting? When we have pushed the case for the cancer bill with the New York State Legislature in the past, the first question is always: “Where are the data about volunteer firefighters?”

This lack of data is cited as reason enough to stall on presumptive cancer legislation. While counting the number of cancers and the number of deaths from cancer may sound straightforward, the methods developed and endorsed by experts in cancer and occupational medicine research as the “gold standard” for determining the magnitude of cancer risks are rigorous and demanding of resources.

Critical Steps to Move Presumptive Cancer Legislation Forward for Volunteers
FASNY and other industry groups work continuously to educate fire service members about ways to reduce exposures and the importance of cancer screenings and early detection. Now, they are committed to collecting the data that will build the case for presumptive cancer legislation needed to help volunteers who develop cancers known to be related to firefighting.

In June 2016, the FASNY Board of Directors approved funding for a cancer study in New York State. This may be the critical step that will be required to finally get the presumptive cancer legislation through the New York State Legislature.

To answer the question of how cancer impacts volunteer firefighters, and obtain the coverage for cancer care and protection of your family, we will need an unprecedented level of commitment to collect the necessary information from fire departments on behalf of their members – active, former or deceased – to establish the FASNY Cohort.

It is fortunate that, with a few notable exceptions (prostate cancer, for example), the specific types of cancer related to firefighting are relatively rare. But, this means that a very large base population will be needed to do the study right. And it’s really important to get it right.

The FASNY Cohort will be the first study of this kind in the U.S.; based on the methods used to conduct the NIOSH 2014 cancer study (whose leaders will provide guidance throughout this new investigation). It may become the model for future studies of volunteers throughout the country. And the best part: The gold standard methodology used to establish presumptive cancer coverage for career firefighters is available to the volunteer service.

To Do This Study, We Need Your Help
You will be hearing more about this study in the weeks to come but here is a very brief outline:

The records that the state Health Department and the Social Security Administration collect for a person’s cancer diagnosis and cause of death, respectively, can be accessed by approved researchers who have demonstrated that they can protect the confidentiality and privacy of the individual’s identity and health information. The names and identifying information of individuals are submitted and linked to the records, then cancer diagnoses or deaths are reported back. The more complete the information, the better the linkage and this is where we need your help.

The study is being conducted by myself as an occupational physician who is the Chair of FASNY’s Health and Wellness Committee and one of the founders of the World Trade Center Health Programs, and Dr. Anne Golden, an occupational epidemiologist who was instrumental in obtaining the data for the Fire Department of New York that led to the first presumptive cancer bill for career firefighters in New York State. We hope to gain your trust, and hope that all of you will agree to participate in this vital study. Together, we will do everything in our power to complete the definitive study to document the cancer risks that impact New York State volunteer firefighters.

We will use this information to fight for you to get the presumptive cancer bill passed. It took 10 long years to get the Zadroga Bill passed after 9/11. I am used to fighting for first responders and, together with Dr. Golden, we will fight for FASNY members until the cancer bill goes through.

1. Firemen’s Association of the State of New York (FASNY) (2015). Firefighters Fighting Cancer.  www.fasny.com/fightcancer
2. Firefighter Cancer Support Network (2014). Taking Action against Cancer in the Fire Service. www.firefightercancersupport.org/wp-content/uploads/2013/08/Taking-Action-against-Cancer-in-the-Fire-Service.pdf
3. Glass D, Sim M, Pircher S, et al. (2014). Final Report Australian Firefighters’ Health Study. www.coeh.monash.org/downloads/finalreport2014.pdf
4. LeMasters GK, Genaidy AM, Succop P, et al. (2006). Cancer risk among firefighters: a review and meta-analysis of 32 studies. J Occup Environ Med, 48(11):1189-202.
5. Daniels RD, Kubale TL, Yiin JH, et al. (2014) Mortality and cancer incidence in a pooled cohort of U.S. firefighters from San Francisco, Chicago and Philadelphia (1950-2009). Occup Environ Med, 71(6):388-97.