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.
