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Lee DJ, Ahn S, McClure LA, Caban-Martinez AJ, Kobetz EN, Ukani H, Boga DJ, Hernandez D, Pinheiro PS. Cancer risk and mortality among firefighters: a meta-analytic review. Front Oncol 2023; 13:1130754. [PMID: 37251928 PMCID: PMC10213433 DOI: 10.3389/fonc.2023.1130754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
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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Affiliation(s)
- David J. Lee
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
| | - Soyeon Ahn
- Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami, Miami, FL, United States
| | - Laura A. McClure
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
| | - Alberto J. Caban-Martinez
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
- Department of Physical Medicine and Rehabilitation, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Erin N. Kobetz
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
- Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Henna Ukani
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Devina J. Boga
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Diana Hernandez
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Paulo S. Pinheiro
- Department Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami Health Systems, Miami, FL, United States
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