Queensland Health investigated a possible cancer cluster at Atherton Fire Station in 2008. An elevated incidence of malignant brain cancer was found but no cause was identified.

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•    Queensland Fire and Rescue Service (QFRS) formed a working party to further investigate the issue. Queensland Health was represented on that group.
•    Monash Centre for Occupational and Environmental Health was commissioned to undertake a study of cancer incidence among Queensland Firefighters. A report on the outcome of that

study is attached.
ISSUES

•    A group of 6964 male and 540 female firefighters who were identified as ever active firefighters, full time or auxiliary, between 1995 and 2006 were studied.
•    The study looked at overall cancer incidence, and specific cancers identified from the literature as having a good or reasonable association with fire fighting.
•    The study found no elevated incidence of cancer overall, and no significant increase in any specific cancer.
•    The number of firefighters in the study was too small to enable meaningful analysis of the incidence of some cancers.
•    At this stage there is no indication that Queensland Health should revise its assessment of the cancer risks to firefighters. However, further investigation into this matter by QFRS is

likely.
STAKEHOLDERS

•    Queensland Fire and Rescue Service commissioned the study.
•    Queensland Fire and Rescue Service Cancer Registry Linkage Working Party members: United Firefighters Union, Queensland Cancer Registry, Department of Employment and Industrial

Relations.
FINANCIAL IMPLICATIONS

Updated assessment of cancer risks to firefighters in Queensland following Monash University study 2009

Monash University have undertaken a study of cancer risk among firefighters in Queensland, hereafter referred to as the Monash study (Monash 2009). In addition to overall cancer risk, the study

looked at specific cancers, identified from the literature, melanoma, prostrate, testis, bladder NHL and MM, that may be associated with a goof or reasonable evidence of an occupational risk.

The study also considered brain cancers, identified in a cluster at Atherton fire station.
Queensland Health undertook a cancer cluster study following the reporting of three cases of malignant brain tumour among firefighters based at Atherton fire station (Queensland Health 2008).

In an investigation of the cluster, Queensland health found an elevated incidence of brain cancer, but did not identify any agents that may account for the clusters.

Firefighters were found to have an elevated risk of some cancers, particularly testicular, prostrate and non-Hodgkin lymphoma in a study of occupational cancers by IARC (2007) The IARC

concluded that occupational exposure as a firefighter was ‘possibly carcinogenic to humans’. QH recommended investigating the feasibility of a wider study of cancers among firefighters in

Queensland to identify if any of the cancers, or brain cancer, were in excess in the wider group.

Firefighters are exposed to many toxic chemicals, including some that are known or suspected carcinogens. Wood smoke contains fine particulate matter (PM10 and PM2.5), carbon monoxide,

formaldehyde, sulphur dioxide and irritant gases such as nitrogen oxides, and carcinogens such as PAHs and dioxins. Wood smoke exposure can depress the immune system, (Vermont

1992).Synthetic materials, such as foam insulation, synthetic carpets, PVC pipe, asphalt tiles, linoleum etc release a range of toxicants including hydrogen chloride, hydrogen cyanide, phosgene

and heavy metals (vermont ref).

The Queensland Health study did not consider the broader issue of the health impacts of smoke, as it was focused on exposure factors that may have been unique to Atherton Fire Station.

Factors considered included exposure to termite treatment, material burnt for a breathing apparatus training facility, diesel exhaust, faulty compressor, radioactive fallout following nuclear

testing in the pacific, and fire fighting foams. The smoke from fires in tobacco drying sheds was considered, but was not considered unique to Atherton.
The Monash study did not attempt to identify exposure to toxicants that may have caused the cancers being investigated.

The Monash study was a retrospective cohort study of Queensland firefighters who were employed for more than 12 months Queensland between 1995 and 2006. The study selected 1995 as the

start date as it was the beginning of computerised employment records, which facilitated the selection of the cohort. From a total of 9415 individuals, 540 women and 69641 men were identified

for inclusion in the study. Person years, the number of the years each individual contributes to study, commenced 12 months after employment, and finished with 2006, death, or for specific

cancers, the diagnosis of the cancer.

The end date of 2006 was chosen as it was the most recent date with complete data in the Queensland Cancer Registry, from which comparison population cancer incidence data was obtained

(classifications ICD-0=O3). Population data was obtained from Australian Bureau of Statistics. This data was used to calculate the expected number of cancers of each type (95% CI). The measure

used in this study, the standardised incident ratio (SIR) is the ratio of expected number of cases to the observed number of cases.

Men and women analysed separately as they have different rates for the specific cancers.  The firefighters were also grouped into the classifications ‘ever active’ and ‘ever full time active’.

The

study identified 217 incidents of cancer among the firefighters, 208 in men and only nine in women.

Results
The study found no excess cancer rate among men who had ever been active firefighters. There was a borderline excess of melanomas (SIR 1.24 (094-1.64) n=51, with all other cancers at or below

expected levels. There was a non-significant increase in kidney and urinary tract cancers (n=10) and a non significant doubling of benign brain tumours (n=3). The small number of cases for these

cancers meant there was not enough power in the statistical tests to determine significance. Most cancers appeared in firefighters who had served more than 20 years, as expected, as most

cancers generally occur in older people. The number of overall cancer incidence among women firefighters (9) was not higher than expected (7.4), The numbers were too small for analysis of

specific cancers to be undertaken.

Discussion
Cancers generally occur with a significant lag time following exposure, and most studies allow a lag-time of 5, 10 or 15 years following exposure to qualify for inclusion in the cohort. In this

study, it was considered that the inclusion of a lag-time months would have significantly reduced the size of the cohort. The study found no difference in the results when only firefighters who

had served more than 12 months, or only full-time firefighters were included. However, half the cohort started work after 1995, thus having a follow up of less than ten years.

Information on factors that may have been confounders or introduced bias into the report were not available. Firefighters who were diagnosed with cancer after moving interstate could not be

counted. There was no data on other exposure factors that may have been relevant, such as sun exposure, cigarette smoking, alcohol intake, and dietary factors.
recommendations

The study provides some reassurance that excess cancers are not occurring among Queensland firefighters. The small size of the cohort, particularly women, limited the ability of the study to

determine incidence rates of specific types of cancer. To overcome these limitations, a longer follow up time, and a larger cohort (Australian firefighters) would be required. At this stage, there

is no requirement for Queensland to revise its assessment of the risks to firefighters.

References
IARC. 2007 Press release No. 180- IARC Monographs Programme finds cancer hazards associated with shiftwork, painting and fire fighting. International Agency for Research on Cancer

http://www.iarc.fr/en/media-centre/pr/2007/pr180.html (date accessed: 16/03/2013)
Monash 2009 Final Report on Queensland Fire Fighters’ Cancer Incidence Study. Monash Centre for Occupational` and Environmental Health, Monash University, Melbourne
Queensland Health 2008 Queensland Health investigation into concerns regarding cases of cancer in firefighters working at Atherton Fire Station.www.emergency.qld.gov.au/…/Final%20report

%20AFS.DOC Accessed 12/3/2013
Vermont 1992 Why Burning is Bad Pamphlet No4.Air Pollution Control Division Waterbury, VT http://ehhi.org/woodsmoke/health_effects.shtml) Accessed 16/03/2013