A Report From The SFFCPF

A Report From The SFFCPF

San Francisco Firefighters Cancer Prevention Foundation

SFFCPF Creation

● Established in 2006● Supported by SFFD Administration and Local

798● 501c3 status gained● Dedicated to the early detection and prevention

of cancer in both active and retired firefighters● Cancer presumptive law

SFFCPF Creation

● Board of Directors formed● Bylaws established● Mission Statement created● Basic strategic plan established● Cancer questionnaire sent out to both active

and retired firefighters

UCSF Bladder Cancer Study● Dr. Marshall Stoller, Assistant Chair

Department of Urology, Dr. Kirsten Greene, Urologist U.C.S.F

● NMP-22 screening (Nuclear Matrix Protein-22)

● Hemastix● 1,286 active and retired firefighters

Study Results● Mean age 45● 93 positive for hematuria● 6 positive for NMP-22● 1 positive for both hematuria and NMP-22● Follow up with urine cytology and

cystoscopy● 2 retired and 1 active diagnosed with T.C.C.

Comparative Statistic

● Age and sex- adjusted incidence for TCC of the bladder is 36 per 100,000

● TCC of the renal pelvis occurs in 1 in 100,000● Study was presented at the Annual Scientific

Meeting of the American Urological Association in 2008

● Study suggests that firefighters may be at a higher risk of developing TCC

How do we reduce toxic exposures?● The question was addressed by the

foundation● Overhaul SOP's were in question● High rates of cancer in arson investigators● Department creates a committee to review

and make changes in the SOP's● It goes nowhere

2008-2009 Fecal Immunochemical Test● Take at home test● 1,203 active and retired firefighters took

part● F.I.T. kit and survey were mailed to those

over 40● Published in the Oxford Journals of

Occupational Health (2014)

F.I.T. results● 445 individuals (37%) completed the survey● 400 individuals (33%) completed the F.I.T.● 45% responded to having had a stool test at

some time● Only 8% had had one in the last year● 36% had had a sigmoidoscopy at some time● Among those aged 50 and older, 59% had had

a test for colon cancer at some time

F.I.T. conclusions

● A workplace intervention can increase CRC screening rates in firefighters

● Future studies should focus on the long term sustainability of this type of program

N.I.O.S.H. Study

● Conducted by researchers from NIOSH in collaboration with researches at the National Cancer Institute and Department of Public Health Sciences at U.C. Davis

● Funding provided by NIOSH with supplemental funding from U.S. Fire Admin.

● Study was done to better understand the potential link between firefighting and cancer.

The study cohort

● 29,993 firefighters from San Francisco, Chicago and Philadelphia

● Phase 1- Focus on those employed between 1950-2009

● Employment info collected for each firefighter

The study cohort

● Determine causes of death and cancer diagnoses from previous studies

● The National Death Index● Death certificates● 11 state cancer registries

N.I.O.S.H. Study Findings

● Firefighters considered to be a healthier population

● Firefighters had more cancer deaths and cancer cases than expected

● Increases in digestive, oral, respiratory, and urinary cancers

● Twice as many malignant mesothelioma cases than expected

N.I.O.S.H. Study Findings

● Higher rates of prostate and bladder cancers in firefighters less than 65 years of age

● Increased bladder cancer mortality and incidence among women firefighters

● Number of deaths from ALL causes of death did not differ from the expected number based on death rates in the general population

● Number of deaths due to cancer in the SFFD from 2000-2009: 151

● Equaled 32% of the total deaths during this time

N.I.O.S.H. Study Phase 2

● Estimate the exposure potential of each study participant

● Examine the relation between exposure and cancer risk

● Follow the career of the firefighters who contracted cancer

Prevention Addressed Again

● Exposure risks during overhaul● Toxic chemical cocktail● Concern rises over PBDE’s exposure

PBDE's

● Flame retardant chemicals, a health hazard?● Persist in the environment● Accumulate in living organisms● Liver toxicity● Thyroid toxicity● Neurodevelopmental toxicity

PBDE's and Firefighters

● Off gas both furans and dioxins● Produce highly corrosive gas: hydrogen

bromide● Bioaccumulate● Have the ability to permeate PPI (CDC

2008 study)

PBDE Pilot Study● 12 firefighters, 2 separate working fires● First study to measure brominated

dioxins/furans● Dr. Susan Shaw, Dr. Kurunthachalam

Kannan, Wadsworth Center, New York State Department of Health, Marine Environmental Research Institute of Maine

Study Results

● PBDE's were dominated by deca-BDE● Deca-dominated pattern is not found in the

general population● Typical pattern found in blood of e-waste

recyclers continuously exposed to deca-BDE from open burning of plastics

Study Results

● San Francisco firefighters showed levels of PBDE's 30% higher than general pop. of CA

● 60% higher than the general pop. of the U.S.● 20 to 30 times higher than levels found in the

general pop. of Japan (Uemura et.al. 2010), Hong Kong (Qin et.al. 2011) and the United Kingdom (Thomas et.al. 2006)

● Negative aspects of the study

Advocates

● 2011 contacted by State Senator Mark Leno● Support SB 147● TB 117 in place since 1975● Very strong chemical lobby

Advocates● 2012 contacted by U.S. Senator Boxer's office● Asked to give testimony supporting the “Safe

Chemicals Act”● Appeared before the “Committee on Environment

and Public Health● Reform of the 1976 “Toxic Substances Control

Act”● Passes committee but dies on the Senate Floor

Breast Cancer Study

● Search the web for studies that have taken place with women firefighters

● Organize a general meeting and invite researchers from throughout the Bay Area to attend.

● A committee is organized to finalize and confirm a list of committed researchers

Women Firefighters Biomonitoring Collaborative● SFFCPF● United Fire Service Women● Silent Spring Institute● School of Public Health and the

Department of Environmental Science, Policy and Management U.C. Berkeley

● U.C.S.F.● $600,000 Grant from The California

Breast Cancer Research Program

General Methodology

● 80 women from the SFFD. 80 women from other civil service positions.

● Blood and urine samples collected● Looking for chemicals linked to breast

cancer including products of combustion

General Methodology

● “Time of flight” technology a non-specific technique that scans the sample for chemicals based on their molecular weight

● Thyroid hormones measured● Melatonin levels measured

Prevention-Reducing Exposures

● Developing safer SOP's during overhaul● Immediate gross decon● Does the culture change?● Firehouse toxic reductions program● Continue the role of Advocacy

Prevention- A Personal Stake

● Diet/Nutrition● Micronutrients/Antioxidants● Isothiocyanates● Phytoflavinoids● Polyphenols● Curcuminoids● Beta Glucans● Vitamin D Levels● 25-Hydroxyvitamin D (50-70 ng/ml)

● Rest

The Outcome● Changes in workers comp● 4 year latency period● No QME visit● A note from the treating physician confirming a diagnosis

of cancer is all that is necessary● No changing of treating physicians● Legislation drawn up and supported by the Mayor for the

city's retirement board to adopt the cancer presumption law for firefighters.

● Greater Awareness

The Future

● Urine metabolite study in conjunction with UCSF, Dr. Marshall Stoller

● Silicone wristband study in conjunction with Dr. Kim Anderson, Oregon State

● Women's biomonitoring study...on-going● Longitudinal study● Continue researching for the latest medically

approved screenings that we can utilize to catch cancer at its earliest stage.