The purpose of this project is to develop and test a framework for establishing a long-term firefighter multicenter prospective cohort study focused on carcinogenic exposures and effects.  The specific aims are to:

1) Establish an oversight and planning board to provide study oversight, foster communication among fire organizations and help develop a long-term funding plan;

2) Create and test a cohort study data coordinating center and harmonized survey data protocols;

3) Develop and evaluate an exposure tracking system paired with quantitative exposure data to construct a firefighter carcinogen exposure matrix; and

4) Create a biomarker analysis center and evaluate the association between cumulative firefighter exposures and epigenetic effects.

Relevance: Cancer is a leading cause of fire service morbidity and mortality, and a recent National Institute for Occupational Safety and Health (NIOSH) study demonstrated an excess mortality rate for cancer in firefighters compared with the general population (Daniels et al., 2014).  Firefighters are exposed to multiple carcinogens in the workplace through skin contamination and inhalation.  However, we currently do not understand which individual exposures are responsible for cancer in firefighters, the mechanisms by which these exposures cause cancer, or effective means of reducing exposures.  Since cancer has a long latency period, biomarkers are also needed that can measure the effects of carcinogen exposure well before the development of cancer, when interventions to prevent disease could be effective.  Development of a large (>10,000 firefighter) multicenter firefighter cancer prospective cohort study will address these needs, but the framework for such a study needs to be first developed and tested among a smaller initial set of fire service partners. 

Methods: The study will build on recent and developing firefighter cancer prevention studies in Arizona, Florida and Massachusetts, adding volunteer and combination fire departments.  1) An Oversight and Planning Board will be established by the Fire Protection Research Foundation (FPRF) in association with the National Fallen Firefighter Foundation (NFFF) Fire Service Occupational Cancer Alliance (FSOCA) to provide oversight of the study through collaboration among fire service organizations, academia, and government agencies, and develop a long-term funding and sustainability plan.  2) A Data Coordination Center will design, develop and evaluate a framework for a multicenter prospective cohort study of firefighters and cancer risk, including standardized participant survey data collection tools and analysis protocols sufficient to address the short- and long-term study objectives as well as linkage with long-term outcome data including cancer development.  3) An Exposure Assessment Center will develop a carcinogen exposure matrix using information gleaned from self-reported and quantitative exposure measurements to provide improved occupational exposure data for comparison with epigenetic outcomes and eventual cancer outcomes.  Carcinogen exposures associated with specific fire types and job tasks will be evaluated across fire departments through exhaled breath monitoring and analysis of urine for absorbed contaminants, providing information to guide exposure reduction strategies.  4) The Biomarker Analysis Center will carry out pilot studies of epigenetic markers of cancer effect and cancer risk comparing firefighters with a range of cumulative exposures and non-firefighter controls.  For these purposes, blood and buccal cells will be collected during annual medical surveillance evaluations. 

Anticipated outcomes: The proposed research will: establish the framework necessary for the subsequent development of a large multicenter cohort study of cancer in the fire service; advance our understanding of firefighter exposures to carcinogens; and help identify biomarkers of carcinogen effect and cancer risk.