Sylvester-Led Study Finds Higher Risk of Skin Cancer Among Florida Firefighters

There is something about being a firefighter in Florida that places these first responders at higher risk for developing skin cancer. It could be workplace exposure to firefighting chemicals, increased UV exposure when they respond to an emergency during daylight hours, a combination of the two and/or other occupational factors.

As part of the Florida Firefighter Cancer Initiative, experts at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System and the Miller School of Medicine, examined survey responses from 2,399 firefighters statewide about cancer and prevention practices. Results revealed 109 cases of skin cancer, affecting 4.5 percent of respondents overall. A total of 17 firefighters had melanoma, 84 had other skin cancers, and 18 had an unknown type of skin cancer. The findings were published as a Research Letter online December 13 in the Journal of the American Medical Association (JAMA) Dermatology.

The rate of melanoma, for example, was higher at 0.7 percent than the 0.011 percent rate reported among the general population in another epidemiology study.

“We believe there are chemicals in the work environment that, when firefighters come into contact with them, might be increasing the risk for specific kinds of cancer,” said study project leader Alberto J. Caban-Martinez, D.O., Ph.D., M.P.H., of Sylvester Comprehensive Cancer Center and the Division of Environment and Public Health in the Department of Public Health Sciences.

“The bigger surprise was that it’s occurring at a younger age among the firefighters,” Caban-Martinez said. According to the study, the mean age at time of skin cancer diagnosis was 42.2 years for melanoma, 38.3 years for non-melanoma, and 42.4 years for unknown skin cancer types in the study.

“If a primary care physician has a patient who is a firefighter, the findings suggest that they make it a point to do a full body skin exam and provide health education on skin cancer protection,” Caban-Martinez said, adding that some patients may not consider skin cancer screening until they’re older, but based on the current data, it may be worthwhile to start full body examinations in this population earlier.

The study builds on Sylvester’s ongoing research into identifying cancer risk factors and preventive interventions for firefighters in Florida.

“Firefighters are already at risk for developing and dying from other cancers, so it’s not surprising to me that our research has now identified that the risk of skin cancer among firefighters is elevated, particularly within the South Florida context,” said Erin Kobetz, Ph.D., M.P.H., senior author of the study and Senior Associate Dean for Health Disparities and Associate Director of Sylvester.

“There are certain occupational-vulnerable groups, including firefighters, who may need more regular skin cancer screening or to start earlier,” Kobetz said.

Funding for this unique initiative has come from an appropriation from the Florida Legislature for the last three years. A bill was introduced in the Florida House last week for $2 million to continue this work and to expand it to other parts of Florida where Sylvester researchers have not had as great a footprint given a lack of geographic proximity.

“The continued legislative support for this cutting-edge science allows us to look at why firefighters are at increased risk of developing skin cancer, and more importantly, come up with solutions to address that disparity,” Kobetz said.

Possible sources of exposure include open spaces in and around firefighters’ protective suits, a lack of proper decontamination of safety gear when firefighters return from an emergency call, and/or exposure to diesel exhaust when firefighting trucks idle with their engines on as firefighters get ready to respond.

This research, like many epidemiologic studies, is designed to be hypothesis generating. The Sylvester investigators are working with co-author Robert S. Kirsner, M.D., Ph.D., the Harvey Blank professor and Chair of Dermatology at the Miller School, to determine more about the biology of how firefighting chemicals could be entering the skin.

“Firefighters save lives while risking their own. Unexpectedly we found that part of the risk is the increased risk of melanoma,” said Kirsner. “Better understanding of why this occurs is needed, but for now better education, prevention and screening are critical next steps.”

The research is also a cohort study, which means investigators plan to follow the same cohort of firefighters on an ongoing basis. Caban-Martinez plans to use the NIOSH Total Worker Health approach to develop effective worksite-based solutions. The Total Worker Health approach not only looks at the individual responsible for their own health and safety, but also examines organizational policies and practices and the integration of health promotion and health protection activities that could decrease their risk of exposure to certain chemicals.

“So we now know skin cancer rates are higher in the firefighter community, so what are some of the interventions we can design on an organizational level?” Caban-Martinez said.

“From an intervention perspective, we also need to think about how we can reduce exposure to the sun in firefighters, creating new proactive policies and procedures to reduce exposure,” Kobetz said.

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