National Firefighter Registry for Cancer

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National Firefighter Registry for Cancer
National Firefighter Registry logo.svg
Program overview
FormedJuly 7, 2018 (2018-07-07)
Parent agencyU.S. National Institute for Occupational Safety and Health
Website https://www.cdc.gov/NFR

The National Firefighter Registry (NFR) for Cancer is a voluntary registry of firefighters in the United States that aims assess cancer rates and risk factors in the U.S. fire service. The NFR collects relevant occupational, lifestyle, and health information from firefighters through an online questionnaire. The goal of the NFR is to use these data to reduce cancer in firefighters.

Contents

The NFR was created by the Firefighter Cancer Registry Act of 2018 [1] in response to growing evidence of carcinogenic exposures (substances that can cause cancer) and increased risk for cancer faced by firefighters. [2] It opened to firefighter for registration in April 2023. [3] [4] [5] The NFR is maintained by the U.S. National Institute for Occupational Safety and Health (NIOSH). [6]

Background

Cancer among firefighters

Photo 1: A firefighter exits a burning building BC2A0522.jpg
Photo 1: A firefighter exits a burning building
Photo 2: Firefighter using a water hose on a fire truck to extinguish a portion of a forest fire DON028 Topanup bushfire 1 III-2015.jpg
Photo 2: Firefighter using a water hose on a fire truck to extinguish a portion of a forest fire

Cancer risk in the U.S. fire service is a topic of growing concern. Firefighters regularly encounter carcinogenic materials—which can cause cancer—and hazardous contaminants on the fireground. [2] [7] Several studies have documented airborne and/or skin exposures to carcinogenic substances during firefighting, as well as contamination on turnout gear and other equipment worn by firefighters. [8] [9] [10] [11] [12]  Some of these compounds can absorb into firefighters' bodies. [13] [14] Some firefighters also work with hazardous materials and are trained to control and clean up dangerous materials such as oil spills and chemical accidents. [15] In addition to chemical exposures, night shift work has been classified by the International Agency for Research on Cancer (IARC) as a probable human carcinogen. [16]

Recent studies suggest that exposure on the fireground may increase risk to firefighters of certain types of cancer and other chronic diseases. [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] In addition to epidemiological studies, several mechanistic studies using biomarkers have found evidence of DNA damage, oxidative stress, and epigenetic changes related to firefighters' exposures. [27] [28] [29] [30] [31] [32] [33]

Unlike structural firefighters, wildland firefighters typically do not wear respiratory protection, and may inhale particulate and other compounds emitted by the wildfires. [34] A risk assessment conducted using an exposure–response analysis concluded that wildland firefighters have an increased risk of dying from lung cancer and cardiovascular disease. [35]

In 2022, IARC completed an evaluation on the carcinogenicity—the ability of a substance or agent to cause cancer—of the occupation of firefighting. IARC reached a consensus that occupational exposure as a firefighter is a known human carcinogen based on sufficient evidence for increased risk of mesothelioma and bladder cancer among firefighters.

Rationale for the NFR

Cancer is a nationally notifiable condition, and thus all U.S. states track diagnoses of cancer in a state cancer registry. [37] While U.S. state cancer registries provide rich data for studying cancer in the U.S., they often do not provide comprehensive information on cancer patients' work history [38] [39] [40] and workplace practices. These limitations, make it challenging to use data from state cancer registries alone to study cancer in firefighters. It is also important to collect information on personal and lifestyle risk factors (e.g. tobacco and alcohol use, sleep deprivation, diet, and physical activity) in the U.S. fire service to better understand how they may affect the relationship between firefighting and cancer. [41] [42] [43]

Due to the lack of central and comprehensive sources of data, research on cancer rates amongst firefighters has been challenging. Although some evidence suggests the risk for specific cancer types could vary for male, female, and non-white firefighters, [44] [45] [46] [47]  the strength of the evidence related to cancer in demographic subgroups is limited because many previous studies have mainly included white male firefighters. Larger studies of female firefighters and racial and ethnic minority groups are needed before conclusions can be drawn about cancer risk across the nation's diverse fire service. [48] [49] [50]

Creation

Firefighter Cancer Registry Act of 2018
Great Seal of the United States (obverse).svg
Long titleAn Act to require the Secretary of Health and Human Services to develop a voluntary registry to collect data on cancer incidence among firefighters
Enacted bythe 115th United States Congress
Citations
Public law Pub. L.   115–194 (text) (PDF) 42 U.S.C.   § 280e-5

The Firefighter Cancer Registry Act of 2018 was introduced in the U.S. House of Representatives on February 7, 2017. [51] [52] This federal legislation required the Centers for Disease Control and Prevention (CDC) to create a registry designed to collect data on cancer rates among U.S. firefighters. [53] [54] [55] The bill was passed with unanimous and bipartisan approval [56] [57] [58] [59] on July 7, 2018. [60]

The main goal of the NFR, according to the text of the law, is "to develop and maintain…a voluntary registry of firefighters to collect relevant health and occupational information of such firefighters for purposes of determining cancer incidence." [61] [62] According to the Republican Policy Committee's summary, the NFR aims to provide decision makers with data to help them create new protocols to protect firefighters. [60] It aims to register around 200,000 firefighters across a variety of demographics within 5 years of launch. [61]

Operation

Video made by NIOSH explaining how the NFR works.

The NFR opened to firefighters for registration in April 2023. [3] As of December 2024, over 17,000 firefighters had signed up via the online portal.

NIOSH recruits firefighters to join the NFR through various communication channels (e.g., NFR website and newsletter, social media, local/state/national unions, affinity groups, trade journals, and conference attendees) and directly from selected rosters of firefighters. [61] [63]


The NFR plans to also seek additional details about participant's types of emergency responses attended and exposures by working with fire departments and exposure tracking programs (if applicable), and by administering follow-up questionnaires to registered firefighters. Because cancer has a long latency period – which is the time between exposure to carcinogens and the development of cancer – the NFR will monitor cancer outcomes for decades. [61] [63]

NIOSH maintains the NFR and receives input and guidance from the NFR Subcommittee, a subcommittee of the NIOSH Board of Scientific Counselors (a Federal Advisory Committee), consisting of 12 rotating subject matter experts in firefighting, epidemiology, medicine, or public health. [64] [65]

Firefighter enrollment

Participation in the NFR is open to all U.S. firefighters aged 18 and older, including:

To complete enrollment in the NFR, firefighters access the NFR enrolment portal through (https://nfr.cdc.gov) to set up an account, sign a consent document, complete a user profile, fill out the enrollment questionnaire. [61] [63]

NIOSH states that the information gathered through the program is only accessible to NIOSH researchers and is protected with multi-factor authentication and "multiple layers of encryption." [63]

The enrollment questionnaire will collect information on employment/workplace characteristics, exposure, demographics, lifestyle factors, comorbidities, and other confounders. Most questions are optional. The enrollment process, including the questionnaire, is designed to take 30–45 minutes to complete if all questions are answered. [61] [63] Following enrollment, NIOSH sends NFR participants notifications for periodic voluntary follow-up questionnaires (e.g., one per year) to be filled out through the web portal. [61] [63]

NIOSH can then use this information to track past and future diagnoses of cancer among NFR participants by matching with data from state cancer registries to understand how firefighters' work impacts their risk of developing cancer. [61] [63]

Incident records

To complement the information gathered directly from firefighters, NIOSH will request fire incident records dating back to January 1, 2010, or earlier when available, from fire departments for some participants. Fire departments are required to collect some basic information about fire incidents under the National Fire Incident Reporting System (NFIRS) established by the U.S. Fire Administration. (The U.S. Fire Administration is in the process of replacing NFIRS with a new system called the National Emergency Response Information System (NERIS).) Department incident records will provide NIOSH scientists with apparatus and incident-specific information to be used for exposure-response analyses.

Specific variables of interest requested from department incident records may include incident number, fire station, apparatus, incident type (e.g., structure fire, car fire, etc.), on scene time, off scene time, job assignments, number of fire runs, and duration at fires. NIOSH will explore the most efficient and least burdensome way of obtaining incident records from participating fire departments. [61] [63]

References

  1. ↑ Rep. Collins, Chris [R-NY-27 (July 7, 2018). "Text - H.R.931 - 115th Congress (2017-2018): Firefighter Cancer Registry Act of 2018". www.congress.gov. Retrieved March 3, 2026.{{cite web}}: CS1 maint: numeric names: authors list (link)
  2. 1 2 Marques, M Matilde; Berrington de Gonzalez, Amy; Beland, Frederick A.; Browne, Patience; Demers, Paul A; Lachenmeier, Dirk W; Bahadori, Tina; Barupal, Dinesh K.; Belpoggi, Fiorella; Comba, Pietro; Dai, Min (June 2019). "Advisory Group recommendations on priorities for the IARC Monographs" . The Lancet Oncology. 20 (6): 763–764. doi:10.1016/S1470-2045(19)30246-3. PMID   31005580. S2CID   128350881.
  3. 1 2 Saurman, Alex (April 20, 2023). "NIOSH's National Firefighter Registry Established to Learn More About Firefighting and Cancer, Increase Health of These First Responders". Occupational Health & Safety. Retrieved September 22, 2023.
  4. ↑ Petrus, Carli (April 18, 2023). "National Firefighter Registry for Cancer could benefit local departments". WTVG. Retrieved September 22, 2023.
  5. ↑ Woodhouse, Murphy (May 12, 2023). "Wildland firefighters strongly encouraged to enroll in new national registry for cancer". Boise State Public Radio. Retrieved September 22, 2023.
  6. ↑ "National Firefighter Registry for Cancer - IAFF". www.iaff.org. September 5, 2019. Retrieved March 3, 2026.
  7. ↑ IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2010). "Painting, firefighting, and shiftwork". IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. 98: 9–764. ISSN   1017-1606. PMC   4781497 . PMID   21381544.
  8. ↑ J. JANKOVIC, W. JONES, J. BURKHART, G. NOONAN (1991). "Environmental study of firefighters". Annals of Occupational Hygiene. 35 (6): 581–602. doi:10.1093/annhyg/35.6.581. PMID   1768008.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. ↑ Bolstad-Johnson, Dawn M.; Burgess, Jefferey L.; Crutchfield, Clifton D.; Storment, Steve; Gerkin, Richard; Wilson, Jeffrey R. (September 2000). "Characterization of Firefighter Exposures During Fire Overhaul" . AIHAJ - American Industrial Hygiene Association. 61 (5): 636–641. doi:10.1080/15298660008984572. ISSN   1529-8663. PMID   11071414.
  10. ↑ Austin, C. C.; Wang, D.; Ecobichon, D. J.; Dussault, G. (July 15, 2001). "Characterization of Volatile Organic Compounds in Smoke at Municipal Structural Fires" . Journal of Toxicology and Environmental Health, Part A. 63 (6): 437–458. doi:10.1080/152873901300343470. ISSN   1528-7394. PMID   11482799. S2CID   36263955.
  11. ↑ Fent, Kenneth W.; Alexander, Barbara; Roberts, Jennifer; Robertson, Shirley; Toennis, Christine; Sammons, Deborah; Bertke, Stephen; Kerber, Steve; Smith, Denise; Horn, Gavin (October 3, 2017). "Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures". Journal of Occupational and Environmental Hygiene. 14 (10): 801–814. doi: 10.1080/15459624.2017.1334904 . hdl: 2142/101922 . ISSN   1545-9624. PMID   28636458. S2CID   44916370.
  12. ↑ Mayer, Alexander C.; Fent, Kenneth W.; Bertke, Stephen; Horn, Gavin P.; Smith, Denise L.; Kerber, Steve; La Guardia, Mark J. (February 1, 2019). "Firefighter hood contamination: Efficiency of laundering to remove PAHs and FRs". Journal of Occupational and Environmental Hygiene. 16 (2): 129–140. doi:10.1080/15459624.2018.1540877. ISSN   1545-9624. PMC   8647047 . PMID   30427284.
  13. ↑ Beitel, Shawn C.; Flahr, Leanne M.; Hoppe-Jones, Christiane; Burgess, Jefferey L.; Littau, Sally R.; Gulotta, John; Moore, Paul; Wallentine, Darin; Snyder, Shane A. (February 1, 2020). "Assessment of the toxicity of firefighter exposures using the PAH CALUX bioassay". Environment International. 135 105207. doi: 10.1016/j.envint.2019.105207 . hdl: 10356/148860 . ISSN   0160-4120. PMID   31812113. S2CID   208870627.
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  21. ↑ Hwang, Jooyeon; Xu, Chao; Agnew, Robert J.; Clifton, Shari; Malone, Tara R. (January 2021). "Health Risks of Structural Firefighters from Exposure to Polycyclic Aromatic Hydrocarbons: A Systematic Review and Meta-Analysis". International Journal of Environmental Research and Public Health. 18 (8): 4209. doi: 10.3390/ijerph18084209 . PMC   8071552 . PMID   33921138.
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  33. ↑ Oliveira, M.; Delerue-Matos, C.; Morais, S.; Slezakova, K.; Pereira, M.C.; Fernandes, A.; Costa, S.; Teixeira, J.P. (March 14, 2018), "Levels of urinary biomarkers of exposure and potential genotoxic risks in firefighters", Occupational Safety and Hygiene VI, CRC Press, pp. 267–271, doi:10.1201/9781351008884-47, ISBN   978-1-351-00888-4 {{citation}}: CS1 maint: work parameter with ISBN (link)
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  51. ↑ Collins, Chris (July 7, 2018). "H.R.931 - 115th Congress (2017-2018): Firefighter Cancer Registry Act of 2018". www.congress.gov. Archived from the original on September 20, 2022. Retrieved September 30, 2022.
  52. ↑ Menendez, Robert (April 25, 2018). "S.382 - 115th Congress (2017-2018): Firefighter Cancer Registry Act of 2018". www.congress.gov. Archived from the original on September 20, 2022. Retrieved September 30, 2022.
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  54. ↑ "US Launches First National Firefighter Cancer Registry". Mesothelioma Center - Vital Services for Cancer Patients & Families. Archived from the original on August 5, 2021. Retrieved September 27, 2022.
  55. ↑ One Hundred Fifteenth Congress of the United States of America (PDF). Archived (PDF) from the original on March 24, 2022.
  56. ↑ Otis, Ginger Adams. "Chuck Schumer wants Congress to create voluntary health registry that tracks firefighters with cancer". nydailynews.com. Archived from the original on March 17, 2022. Retrieved March 17, 2022.
  57. ↑ "Breaking News: House Unanimously Approves Firefighter Cancer Registry Act – Virginia Department of Fire Programs". www.vafire.com. Archived from the original on June 29, 2022. Retrieved September 30, 2022.
  58. ↑ "H.R. 931 Archives". Congressional Fire Services Institute. Archived from the original on November 26, 2020. Retrieved September 30, 2022.
  59. ↑ "Bipartisan Firefighter Cancer Registry Act Signed into Law". U.S. Senator Amy Klobuchar. Archived from the original on September 20, 2022. Retrieved September 30, 2022.
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  62. ↑ "National Firefighter Registry". IAFF. Archived from the original on January 11, 2022. Retrieved September 30, 2022.
  63. 1 2 3 4 5 6 7 8 "National Firefighter Registry - FAQ". U.S. National Institute for Occupational Safety and Health. September 6, 2022. Retrieved September 15, 2022.
  64. ↑ "National Firefighter Registry Subcommittee (NFRS)". U.S. National Institute for Occupational Safety and Health. September 6, 2022. Retrieved September 15, 2022.
  65. ↑ NFFF (June 8, 2021). "National Firefighter Registry Updates". Everyone Goes Home. Archived from the original on September 20, 2021. Retrieved September 30, 2022.
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