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How much more evidence do we need to clarify the fact that firefighters are at greater risk of cancer and other diseases than the general public, before legislation for health screening and compensation is put in place? The fight for recognition of this in the UK continues, while countries like the USA, Canada and Australia have already provided health and financial support for their operational fire crews.
FIRE has repeatedly reported on the dangers of fire effluents found in soot and smoke, from the physiological, immunological and contaminant monitoring of firefighters and instructors carried out by the University of Brighton and the University of Roehampton that started in 2018, to the University of Central Lancashire’s (UCLan) study and toxicity report published in 2020, and subsequent introduction of a nationwide database to assess the link between firefighters and fatal diseases. But it seems this research is not enough to influence a decision on legislation for firefighters in the UK.
On March 25, 2021, the Industrial Injuries Advisory Council (IIAC) published their decision following a comprehensive review of all literature relating to cancer in firefighters and a summary of potential carcinogens to which firefighters may potentially be exposed. The following is a summary of that decision:
‘There are a large number of published studies investigating cancer risk in firefighters from many countries. There is consistent evidence that mortality and cancer incidence in firefighters for all cancers considered together do not show any excess risk compared to the general population. Increased risks associated with firefighting for specific cancer sites have been found, but the types of cancer and the magnitude of the risk estimates vary considerably between studies and between countries, study date and length of employment of the firefighters. In addition, the risks are generally less than doubled.
‘Thus, the Council did not find consistent evidence that the risk of any type of cancer is more likely than not to be due to firefighting ie the risk was more than doubled… The Council has therefore decided against recommending prescription for cancer in firefighters, but it remains open to the possibility of reviewing its position as the research evidence base continues to grow’.
Scottish Firefighters Occupational Cancer and Disease Mortality Rates: 2000-2020
With the reasons for this decision in mind, let us fast forward to January 2023; the latest study on this subject, commissioned by the Fire Brigades Union (FBU) and independently carried out by Professor Anna Stec and her team at UCLan, has just been published and reports that: ‘Significant overall excess cancer mortality was found for Scottish firefighters compared with the general population’. The study, titled Scottish Firefighters Occupational Cancer and Disease Mortality Rates: 2000-2020, analysed deaths from cancer and other diseases in Scottish male firefighters compared with the general male Scottish population. The results can be considered representative of the whole of the UK because our fire services face the same conditions in Scotland as the rest of the UK and follow the same operational procedures.
Riccardo la Torre, FBU National Officer
The study analysed mortality records from the National Records of Scotland and the findings indicate that firefighters’ mortality rate from all cancers is 1.6 times more likely than the general population, which is worrying, but not the double figure required by the IIAC. However, when specific types of cancer were analysed, the results were significantly higher. For example:
Prostate – 3.8 times more likely
Leukaemia – 3.17 times more likely
Oesophagus – 2.42 times more likely.
In instances where cancer with an unknown origin has spread, the rate was 6.37 times higher than the general population.
The study also revealed that firefighters are dying from heart attack and musculoskeletal system diseases at five times the rate of the general public, more than three times the rate from both interstitial pulmonary disease and renal failure and almost three times the rate from a stroke.
The UCLan report, published in the Oxford Journal of Occupational Medicine, highlights that the higher cancer mortality observed in the specific types of cancer are likely due to different yet frequent types of exposure to fire effluents. For example, Oesophageal cancers point to a significant contribution from ingestion. Ingestion can occur when firefighters swallow saliva in which fire effluent has become trapped, or by eating food with contaminated hands. The report also states that over 85 per cent of recently surveyed UK firefighters reported noticing soot in their nose and throat after attending a fire.
It is also made clear in the report that fire effluents and toxins are more prevalent in our modern world because of the increase in synthetic materials that are replacing the use of natural ones. This supports the following findings that I find particularly worrying: Figure 2 from the study (pictured), which illustrates the total number of disease and cancer deaths for the general population and firefighters from 2000-2020. There is a general decline in the number of deaths for the general population, which indicates the increasing availability of life-saving measures such as early diagnosis and new and improved treatments. However, firefighters display a concerning upward trend in the number of firefighter deaths, more so in the figures for cancer than for other diseases. This indicates a reaction to the increase in toxic fumes created by modern fires.
Professor Anna Stec, University of Central Lancashire
Figure 2: Total number of (A) disease and (B) cancer deaths from 2000 to 2020, for general population and firefighters
I asked the IIAC if it will be reconsidering its decision in light of this new evidence, and I received a prompt and detailed response: ‘IIAC is aware of the recent publication and has obtained copies of the paper. This will be reviewed by IIAC members and will be discussed at the next meeting of its subgroup, the research working group.
‘For context, below is a brief explanation of the processes IIAC follows when considering evidence for a topic.
‘For certain diseases, IIAC’s decision is straightforward. Some diseases only occur due to particular work (eg pneumoconiosis in coal miners); or are almost always associated with work (eg mesothelioma in the UK); or have specific medical tests that prove their link with work (eg occupational asthma or dermatitis); or have a rapid link to exposure or other clinical features that make it easy to confirm the work connection (eg certain infections and chemical poisonings). In situations like these, IIAC would recommend prescription of the disease.
‘For many other diseases, the decision is less clear-cut. Problems arise over diseases that can also occur in the wider public, and not just because of a particular type of work. For example, lung cancer can be caused by asbestos, but is also caused by smoking, and can occasionally occur without an apparent cause. What makes things particularly difficult is that, for these diseases, there is no reliable way in an individual case to tell whether disease has been caused by work or not. All that can be said is that the disease may be more probable in a worker with a specific work history than an individual without that same history.
‘The question in law for these less clear-cut diseases is: ‘Is it reasonably certain that work caused the person’s disease?’ Corresponding to this, IIAC looks for evidence that the disease is likely to be due to work on the balance of probabilities (or put another way ‘more likely than not’). This is the standard of proof that is normally needed in civil courts of law and social security tribunals.
‘Good quality scientific evidence is needed before prescription can be recommended and before making a decision about prescription IIAC considers:
the quantity of data, particularly the number of research studies, pointing to a particular conclusion;
its quality (and what the best reports show);
the findings in workers with the heaviest exposures;
the biological plausibility of reported findings; and
whether the findings can be applied to groups of workers in the UK.
‘Possible biases in the research studies are also considered, as well as how to define the qualifying exposure(s) in a practical way that would allow the benefit to be delivered. For the less clear-cut situations, IIAC normally seeks evidence that the “relative risk” (“RR”) in a particular job is more than 2’.
In response to the publication of the UCLan report, Riccardo la Torre, FBU National Officer, has released the following statement: “This is a study that should horrify fire services and the government. This is about firefighters dying who did not need to. We know that there are clear ways we can make things better for firefighters. We need health surveillance. We need monitoring of exposures. We need legislation that will ensure that affected firefighters are given the compensation they deserve. At the moment we are sorely lacking in all of these areas. It is high time that ends. We cannot lose any more firefighters unnecessarily. Lives are being lost amongst our friends and colleagues and it must stop. We need to catch problems early and mitigate problems early.”
Professor Anna Stec from UCLan has also voiced concern, stating: “This is the first study of its kind in UK and the research brings to light the wide range of occupational hazards that firefighters face. It’s important that firefighters can continue to do their jobs as safely as possible, and the research shows that measures such as health monitoring and reducing exposure from contaminants at the workplace will play an important part in protecting firefighters.”
“We cannot lose any more firefighters unnecessarily. Lives are being lost amongst our friends and colleagues and it must stop. We need to catch problems early and mitigate problems early”
Riccardo la Torre, FBU National Officer
It is now also being widely reported in the media. Just a few days after the publication of this latest UCLan study and following an investigation by The Mirror up to a dozen firefighters who responded to the Grenfell Tower tragedy were diagnosed with cancer, the majority of which were reported to be digestive cancers and leukaemia. The Mirror reported that there were fears this may only be the start of a larger problem, because cancer can take up to 25 years to be diagnosed.
It is not only cancers that have been diagnosed in firefighters who attended Grenfell; kidney failure, heart disease and strokes have also been recorded in higher numbers than usual, believed to be as a result of the extreme physical exertion and exhaustion they would have experienced when attending to the disastrous event. Survivors of the tragedy and local residents are also concerned about the possibility of future health problems, and there have been calls for health screening.
In 2019, Professor Anna Stec and her team at UCLan studied the Grenfell site after the awful event and analysed soil, debris and char samples of insulation boards used on the tower. Their tests revealed heightened concentrations of cancer-causing chemicals and proven carcinogens, including benzene, within 140 metres of the tower. The study raised concerns that these findings could lead to an increased risk of cancer and respiratory problems of those living in the area. Anna Stec said then, as she is still saying today: “It is now crucial to put in place long-term health screening to assess any long-term adverse health effects of the fire on local residents, emergency responders and clean-up workers. This will also provide a future readiness for dealing with any further such disasters.”
Many firefighters who attended the tragedy were contained in the building in their contaminated suits for up to ten hours, and some waited in the smoke-logged basement of the tower block for up to six hours. One firefighter who responded to Grenfell told The Mirror: “What is out of the ordinary was the length of time we were there… In a standard fire you would be there not more than four hours. When you get to that mark you get a relief crew. But I was at Grenfell for eight hours, twice as long as I should have been.”
The IIAC informed me that they will be discussing the latest report from UCLan in their next meeting of the research working group. The minutes of all their meetings are published on their website for the public to view, so I will be checking regularly for the outcome of their discussions on this particularly hot topic.
The most recent UCLan study can be viewed in full via this news report on the UCLan website: https://www.uclan.ac.uk/news/firefighter-mortality-rate
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