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. 2025 Apr 22:14:e70522.
doi: 10.2196/70522.

The Fire Fighter Cancer Cohort Study: Protocol for a Longitudinal Occupational Cohort Study

Jefferey L Burgess  1 , Shawn C Beitel  1 , Miriam M Calkins  2 , Melissa A Furlong  1 , Paola Louzado Feliciano  3 , Jamie Kolar Gabriel  4 , Casey Grant  5 , Jaclyn M Goodrich  6 , Judith M Graber  7 , Olivia Healy  1 , James Hollister  8 , Jeff Hughes  9 , Sara Jahnke  10 , Krystal Kern  1 , Frank A Leeb  11 , Alberto J Caban-Martinez  12 , Alexander C Mayer  2 , Russell Osgood  13 , Cynthia Porter  8 , Sreenivasan Ranganathan  14 , Heather M Stapleton  15 , Natasha Schaefer Solle  12 , Christine Toennis  2 , Derek J Urwin  4   16 , Michelle Valenti  8 , John J Gulotta  17
Affiliations

The Fire Fighter Cancer Cohort Study: Protocol for a Longitudinal Occupational Cohort Study

Jefferey L Burgess et al. JMIR Res Protoc. .

Abstract

Background: Firefighters are at an increased risk of cancer and other health conditions compared with the general population. However, the specific exposures and mechanisms contributing to these risks are not fully understood. This information is critical to formulate and test protective interventions.

Objective: The purpose of the Fire Fighter Cancer Cohort Study (FFCCS) is to conduct community-engaged research with the fire service to advance the evaluation and reduction of firefighter exposures, along with understanding and mitigating effects leading to an increased risk of cancer and other health conditions. This involves establishing a long-term (>30 years) firefighter multicenter prospective cohort study.

Methods: The structure of the FFCCS includes a fire service oversight and planning board to provide guidance and foster communication between researchers and fire organizations; a data coordinating center overseeing survey data collection and data management; an exposure assessment center working with quantitative exposure data to construct a firefighter job exposure matrix; and a biomarker analysis center, including a biorepository. Together, the centers evaluate the association between firefighter exposures and toxic health effects. Firefighter research liaisons are involved in all phases of the research. The FFCCS research design primarily uses a set of core and project-specific survey questions accompanied by a collection of biological samples (blood and urine) for the analysis of biomarkers of exposure and effect. Data and samples are collected upon entry into the study, with subsequent collection after eligible exposures, and at intervals (eg, 1-2 years) after enrollment. FFCCS data collection and analysis have been developed to evaluate unique exposures for specific firefighter groups; cancer risks; and end points in addition to cancer, such as reproductive outcomes. Recruitment is carried out with coordination from partnering fire departments and eligible participants, including active career and volunteer firefighters in the United States.

Results: The FFCCS protocol development was first funded by the US Federal Emergency Management Agency in 2016, with enrollment beginning in February 2018. As of September 2024, >6200 participants from >275 departments across 31 states have enrolled, including recruit and incumbent firefighters. Biological samples have been analyzed for measures of exposure and effect. Specific groups enrolled in the FFCCS include career and volunteer structural firefighters, women firefighters, trainers, fire investigators, wildland firefighters, firefighters responding to wildland-urban interface fires, and airport firefighters. Peer-reviewed published results include measurement of exposures and the toxic effects of firefighting exposure. Whenever possible, research results are provided back to individual participants.

Conclusions: The FFCCS is a unique, community-engaged, multicenter prospective cohort study focused on the fire service. Study results contribute to the evaluation of exposures, effects, and preventive interventions across multiple sectors of the US fire service, with broad implications nationally.

International registered report identifier (irrid): DERR1-10.2196/70522.

Keywords: biomonitoring; cancer; firefighter; prospective cohort study; protocol.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
The Fire Fighter Cancer Cohort Study’s (FFCCS) organizational structure. IRB: institutional review board; REDCap: Research Electronic Data Capture.
See this image and copyright information in PMC

References

    1. U.S. fire administration website applications. National Fire Department Registry Quick Facts. [2024-12-11]. https://apps.usfa.fema.gov/
    1. Daniels RD, Kubale TL, Yiin JH, Dahm MM, Hales TR, Baris D, Zahm SH, Beaumont JJ, Waters KM, Pinkerton LE. Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009) Occup Environ Med. 2014 Jun 14;71(6):388–97. doi: 10.1136/oemed-2013-101662. https://europepmc.org/abstract/MED/24142974 oemed-2013-101662 - DOI - PMC - PubMed
    1. Tsai RJ, Luckhaupt SE, Schumacher P, Cress RD, Deapen DM, Calvert GM. Risk of cancer among firefighters in California, 1988-2007. Am J Ind Med. 2015 Jul;58(7):715–29. doi: 10.1002/ajim.22466. https://europepmc.org/abstract/MED/25943908 - DOI - PMC - PubMed
    1. Lee DJ, Koru-Sengul T, Hernandez MN, Caban-Martinez AJ, McClure LA, Mackinnon JA, Kobetz EN. Cancer risk among career male and female Florida firefighters: evidence from the Florida Firefighter Cancer Registry (1981-2014) Am J Ind Med. 2020 Apr 12;63(4):285–99. doi: 10.1002/ajim.23086. - DOI - PubMed
    1. Demers PA, DeMarini DM, Fent KW, Glass DC, Hansen J, Adetona O, Andersen MH, Freeman LE, Caban-Martinez AJ, Daniels RD, Driscoll TR, Goodrich JM, Graber JM, Kirkham TL, Kjaerheim K, Kriebel D, Long AS, Main LC, Oliveira M, Peters S, Teras LR, Watkins ER, Burgess JL, Stec AA, White PA, DeBono NL, Benbrahim-Tallaa L, de Conti A, El Ghissassi F, Grosse Y, Stayner LT, Suonio E, Viegas S, Wedekind R, Boucheron P, Hosseini B, Kim J, Zahed H, Mattock H, Madia F, Schubauer-Berigan MK. Carcinogenicity of occupational exposure as a firefighter. Lancet Oncol. 2022 Aug;23(8):985–6. doi: 10.1016/s1470-2045(22)00390-4. - DOI - PubMed