Meta-Analysis

. 2017 Nov 17;16(1):124.

doi: 10.1186/s12940-017-0336-z.

Prostate cancer in firefighting and police work: a systematic review and meta-analysis of epidemiologic studies

Jeavana Sritharan^{1

2}, Manisha Pahwa³, Paul A Demers^{4

5

6

7}, Shelley A Harris^{3

8

9}, Donald C Cole⁸, Marie-Elise Parent¹⁰

Affiliations

¹ Occupational Cancer Research Centre, Cancer Care Ontario, 525 University Avenue, Toronto, ON, M5G 2L3, Canada. jeavana.sritharan@occupationalcancer.ca.
² Institute of Medical Science, University of Toronto, 525 University Avenue, Toronto, ON, M5G 2L3, Canada. jeavana.sritharan@occupationalcancer.ca.
³ Occupational Cancer Research Centre, Cancer Care Ontario, 525 University Avenue, Toronto, ON, M5G 2L3, Canada.
⁴ Occupational Cancer Research Centre, Cancer Care Ontario, 525 University Avenue, Toronto, ON, M5G 2L3, Canada. paul.demers@cancercare.on.ca.
⁵ Institute of Medical Science, University of Toronto, 525 University Avenue, Toronto, ON, M5G 2L3, Canada. paul.demers@cancercare.on.ca.
⁶ CAREX Canada, Simon Fraser University, Burnaby, Canada. paul.demers@cancercare.on.ca.
⁷ Dalla Lana School of Public Health, University of Toronto, 525 University Avenue, Toronto, ON, M5G 2L3, Canada. paul.demers@cancercare.on.ca.
⁸ Dalla Lana School of Public Health, University of Toronto, 525 University Avenue, Toronto, ON, M5G 2L3, Canada.
⁹ Population Health and Prevention, Cancer Care Ontario, 525 University Avenue, Toronto, ON, M5G 2L3, Canada.
¹⁰ INRS-Institut Armand-Frappier, University of Quebec, 531 Boulevard des Prairies, Laval, Quebec, H7V 1B7, Canada.

PMID: 29149887
PMCID: PMC5693511
DOI: 10.1186/s12940-017-0336-z

Meta-Analysis

Prostate cancer in firefighting and police work: a systematic review and meta-analysis of epidemiologic studies

Jeavana Sritharan et al. Environ Health. 2017.

. 2017 Nov 17;16(1):124.

doi: 10.1186/s12940-017-0336-z.

Authors

Jeavana Sritharan^{1

2}, Manisha Pahwa³, Paul A Demers^{4

5

6

7}, Shelley A Harris^{3

8

9}, Donald C Cole⁸, Marie-Elise Parent¹⁰

Affiliations

¹ Occupational Cancer Research Centre, Cancer Care Ontario, 525 University Avenue, Toronto, ON, M5G 2L3, Canada. jeavana.sritharan@occupationalcancer.ca.
² Institute of Medical Science, University of Toronto, 525 University Avenue, Toronto, ON, M5G 2L3, Canada. jeavana.sritharan@occupationalcancer.ca.
³ Occupational Cancer Research Centre, Cancer Care Ontario, 525 University Avenue, Toronto, ON, M5G 2L3, Canada.
⁴ Occupational Cancer Research Centre, Cancer Care Ontario, 525 University Avenue, Toronto, ON, M5G 2L3, Canada. paul.demers@cancercare.on.ca.
⁵ Institute of Medical Science, University of Toronto, 525 University Avenue, Toronto, ON, M5G 2L3, Canada. paul.demers@cancercare.on.ca.
⁶ CAREX Canada, Simon Fraser University, Burnaby, Canada. paul.demers@cancercare.on.ca.
⁷ Dalla Lana School of Public Health, University of Toronto, 525 University Avenue, Toronto, ON, M5G 2L3, Canada. paul.demers@cancercare.on.ca.
⁸ Dalla Lana School of Public Health, University of Toronto, 525 University Avenue, Toronto, ON, M5G 2L3, Canada.
⁹ Population Health and Prevention, Cancer Care Ontario, 525 University Avenue, Toronto, ON, M5G 2L3, Canada.
¹⁰ INRS-Institut Armand-Frappier, University of Quebec, 531 Boulevard des Prairies, Laval, Quebec, H7V 1B7, Canada.

PMID: 29149887
PMCID: PMC5693511
DOI: 10.1186/s12940-017-0336-z

Abstract

Objectives: We conducted a systematic review and meta-analysis to evaluate potential associations between firefighting and police occupations, and prostate cancer incidence and mortality.

Methods: Original epidemiological studies published from 1980 to 2017 were identified through PubMed and Web of Science. Studies were included if they contained specific job titles for ever/never firefighting and police work and associated prostate cancer risk estimates with 95% confidence intervals (CI). Study quality was assessed using a 20-point checklist. Prostate cancer meta-risk estimates (mRE) and corresponding 95% CIs were calculated for firefighting and police work separately and by various study characteristics using random effects models. Between-study heterogeneity was evaluated using the I² score. Publication bias was assessed using Begg's and Egger's tests.

Results: A total of 26 firefighter and 12 police studies were included in the meta-analysis, with quality assessment scores ranging from 7 to 19 points. For firefighter studies, the prostate cancer incidence mRE was 1.17 (95% CI = 1.08-1.28, I² = 72%) and the mortality mRE was 1.12 (95% CI = 0.92-1.36, I² = 50%). The mRE for police incidence studies was 1.14 (95% CI = 1.02-1.28; I² = 33%); for mortality studies, the mRE was 1.08 (95% CI = 0.80-1.45; I² = 0%). By study design, mREs for both firefighter and police studies were similar to estimates of incidence and mortality.

Conclusion: Small excess risks of prostate cancer were observed from firefighter studies with moderate to substantial heterogeneity and a relatively small number of police studies, respectively. There is a need for further studies to examine police occupations and to assess unique and shared exposures in firefighting and police work.

Keywords: Epidemiology; Firefighters; Incidence; Meta-analysis; Mortality; Occupation; Police; Prostate cancer risk; Systematic review.

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The authors declare that they have no competing interests.

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Figures

**Fig. 1**
Descriptive flow chart of study selection in this meta-analysis

**Fig. 2**
Forest plot and mRE of all included prostate cancer incidence studies on firefighters

**Fig. 3**
Forest plot and mRE of all included prostate cancer mortality studies on firefighters

**Fig. 4**
Forest plot and mRE of all included prostate cancer incidence studies on police workers

**Fig. 5**
Forest plot and mRE of all included prostate cancer mortality studies on police workers

See this image and copyright information in PMC

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