Firefighting and Cancer: A Meta-analysis of Cohort Studies in the Context of Cancer Hazard Identification
10.1016/j.shaw.2023.02.003
- Author:
Nathan L. DEBONO
1
;
Robert D. DANIELS
;
Laura E. Beane FREEMAN
;
Judith M. GRABER
;
Johnni HANSEN
;
Lauren R. TERAS
;
Tim DRISCOLL
;
Kristina KJAERHEIM
;
Paul A. DEMERS
;
Deborah C. GLASS
;
David KRIEBEL
;
Tracy L. KIRKHAM
;
Roland WEDEKIND
;
Adalberto M. FILHO
;
Leslie STAYNER
;
Mary K. SCHUBAUER-BERIGAN
Author Information
1. Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
- Publication Type:Review Article
- From:Safety and Health at Work
2023;14(2):141-152
- CountryRepublic of Korea
- Language:English
-
Abstract:
Objective:We performed a meta-analysis of epidemiological results for the association between occupational exposure as a firefighter and cancer as part of the broader evidence synthesis work of the IARC Monographs program.
Methods:A systematic literature search was conducted to identify cohort studies of firefighters followed for cancer incidence and mortality. Studies were evaluated for the influence of key biases on results. Random-effects meta-analysis models were used to estimate the association between ever-employment and duration of employment as a firefighter and risk of 12 selected cancers. The impact of bias was explored in sensitivity analyses.
Results:Among the 16 included cancer incidence studies, the estimated meta-rate ratio, 95% confidence interval (CI), and heterogeneity statistic (I2) for ever-employment as a career firefighter compared mostly to general populations were 1.58 (1.14–2.20, 8%) for mesothelioma, 1.16 (1.08–1.26, 0%) for bladder cancer, 1.21 (1.12–1.32, 81%) for prostate cancer, 1.37 (1.03–1.82, 56%) for testicular cancer, 1.19 (1.07–1.32, 37%) for colon cancer, 1.36 (1.15–1.62, 83%) for melanoma, 1.12 (1.01–1.25, 0%) for non-Hodgkin lymphoma, 1.28 (1.02–1.61, 40%) for thyroid cancer, and 1.09 (0.92–1.29, 55%) for kidney cancer. Ever-employment as a firefighter was not positively associated with lung, nervous system, or stomach cancer. Results for mesothelioma and bladder cancer exhibited low heterogeneity and were largely robust across sensitivity analyses.
Conclusions:There is epidemiological evidence to support a causal relationship between occupational exposure as a firefighter and certain cancers. Challenges persist in the body of evidence related to the quality of exposure assessment, confounding, and medical surveillance bias.
