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A Report From The SFFCPF. San Francisco Firefighters Cancer Prevention Foundation. 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. - PowerPoint PPT Presentation
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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.