Cancer among Firefighters: The "under-the-skin" Hazard
The obvious and acute dangers of battling fires are not the only risks faced by firefighters. There are also medium and long-term health risks. The latter, like the former, can, however, be reduced – through appropriate protective equipment and appropriate behavior. We spoke with Marcus Bätge, CEO of FeuerKrebs gUG, a charitable foundation whose name literally means fire cancer or fire-related cancer.14 Oct 2019
Mr. Bätge, when did you first hear of occupational cancer in the fire service, and what motivated you to get involved with combating it?
I was at an executive meeting of our professional body in May 2014 where a colleague reported on the elevated risk of cancer among firefighters and the fact that it’s a risk fire departments are increasingly focusing on worldwide. Naturally I wanted to find out more. Apart from that, my father was a thyroid cancer survivor. His cancer had nothing to do with firefighting, of course, but it gave me an understanding of how people feel when they receive such a diagnosis and the sudden and profound ways in which it can change their lives. Following that, I took up an invitation from the European Fire Fighters Unions Alliance to travel to Norway to attend the “3rd Seminar on Occupational Cancer among Firefighters”.
What was the message you took from the seminar?
The information we received there gave us cause to suspect that the cancer topic would have major resonance in Germany, too. After all, cardiovascular disease and post-traumatic stress disorder are not the only long-term health issues we face in the fire service; cancer is also part of the spectrum. The seminar in Norway has since given rise to an extensive network of contacts spanning Germany, Canada, Australia and Scandinavia and ultimately led to the creation of FeuerKrebs gUG. FeuerKrebs is the only foundation of its kind in Germany.
Speaking of your foundation’s name, what exactly does "fire-related cancer" mean?
The nature of fires has changed a lot. Even just 20 years ago, the average house fire would have involved a lot of natural-wood furniture, but these days most furniture and furnishings are made of engineered materials and plastics, which burn differently and give off gases that are more toxic and carcinogenic. This can lead to an increase of up to 30 percent in the risk of cancer – and that’s what people, not least the media here in Germany, mean when they talk of "fire-related cancer".
To what extent is that a recognized diagnosis?
For sufferers, it’s very difficult to demonstrate a direct link between their cancer and their occupation as a firefighter and hence establish a diagnosis of fire-related cancer. In that regard it’s a lot like post-traumatic stress disorder: it’s nearly impossible to meet the evidentiary standards required to have the condition classified as being the result of an employment-related accident or recognized as an occupational disease. The other challenge is that with cancer, the latency period – that’s the time between initial exposure and when you first evidence signs of the ailment – is often several years. The onus is always on the sufferer to establish the necessary causal link, and with long latency periods, that’s very difficult.
Asbestosis, of course, is an exception to this. It is a recognized condition which can arise anything up to 40 years after work-related exposure to asbestos and other fibrous materials. Unfortunately, for our kind of work there is no such diagnosis, no such direct, concrete correlation between exposure and specific types of cancer.
Is there any chance that might change?
There is a glimmer of hope on the horizon. In the case of skin, prostate and testicular cancers and non-Hodgkin lymphoma there are already good grounds to suspect that working with what are known as polycyclic aromatic hydrocarbons (PAHs) is a risk factor. There are in fact a number of recognized cases – among chimney sweeps, for example.
You are in contact with fire service professionals who are affected by fire-related cancer. Is it possible to pinpoint where they may have been exposed to serious risk factors?
That’s right: we are in contact with a number of sufferers, some of whom we’ve gotten to know personally. They can recall specific call-out locations where they’ve been absolutely covered in soot and muck and, looking back, they can’t help wondering whether they may have been exposed to something. And that’s to say nothing of all the run-of-the mill call-outs – dumpster fires, stove fires, "normal" house fires and the like – where they are almost certain to have inhaled something nasty. In those days, as fire service professionals, we answered the call, headed out and did our job, and then returned to the station and resumed our normal routines without paying a thought to hygiene practices or indeed taking any measures to prevent cross-contamination, let alone a shower. Obviously there were fire reports filed, but the crew members involved were not listed and documented by name as they are now since the new hazardous substances regulations became law a couple of years ago.
What are the key measures that can be taken to reduce the risk of occupational cancer among firefighters?
As part of my training, I learned about the importance of avoiding contamination and taking measures to prevent contaminant absorption, whether by ingestion, inhalation/aspiration or contact with the skin. The key is to practice rigorous hygiene while attending the incident and to avoid cross-contamination afterwards. That means removing or changing soiled personal protective equipment at the earliest opportunity – it will continue to give off hazardous substances for quite some time after use – and washing your hands, arms and face before eating. Ideally you should take a shower or even a sauna. The German Fire Protection Association’s environmental protection division has put out a comprehensive guideline that documents all this. Simply being aware of and implementing the measures recommended in that document goes a long way towards better health, plus it’s a fairly inexpensive fix. Another approach is to get manufacturers to improve our (protective) equipment – there’s certainly scope for that! Another potential measure in the quest to reduce the incidence of cancer is medical screening – detecting the disease early on, before the individual presents with symptoms.
How difficult is it to raise awareness of the need for better firefighter hygiene?
Raising awareness and instilling in people a willingness to abandon old habits, behaviors and ways of doing things is, I believe, the biggest challenge of all. All too often the response is: "But we've always done it that way!" And then there’s that tradition of keeping smoke-ridden protective clothing and dirty helmets around the fire station as mementos of particular acts of heroism in the line of duty. I suspect we’ll have a lot of work do before things like that are no longer a factor. That’s why we need a two-pronged approach. We need to educate our new recruits and we need to raise awareness among our older, more experienced team members.
What are the least-known hazards?
Our first line of defense at incident sites consists of personal protective equipment and breathing apparatus. We can usually also minimize general incident-site risks through careful tactical planning. But one thing not many people know is that the bulk of the substances and particles we encounter when attending fires can be absorbed transdermally – they can pass through the pores in our skin and into our bodies.
How does that work exactly?
When our body temperature rises as we work to fight a fire, our sweat production increases and our pores open up. Now, sweating is a good thing, because the positive pressure it creates acts as a barrier, preventing the substances on the surface of our skin from penetrating any deeper. The problem is when our body temperature drops back down after the hard work is done because at that point, sweat production trails off or stops altogether, but our pores have not yet closed, so there’s no protective barrier and the substances can pass into our bodies, into our cells, unhindered. The absorption rate can be up to 400 times what it was during peak sweat production. And the more fires we are exposed to, the greater the stress on our cells.
And so taking a shower can actually help with that?
Have you ever smelled your hair or clothing after sitting round a campfire? The smell of fire and smoke and the particles on the skin are so pervasive and stubborn that often it is not enough for firefighters to wash their hair or body just once. The next time they shower, they’ll often notice that the wastewater going into the drain is still discolored. The recommendation, therefore, is that they should shower as soon as possible after fighting a fire: once in cold water (3 to 5 minutes) and once in warm water, using soap (3 to 5 minutes).
What progress have professional and volunteer fire services made in terms of preventing occupational cancers?
In many places, the message still hasn’t gotten through that we have a problem with firefighter hygiene – and that cuts across both professional and volunteer brigades. Often there is no awareness of the need for hygiene, as the risks tend to be seen as more abstract or remote, with no direct link to the firefighting task at hand. In terms of the hazards involved, an overturned fuel tanker leaking liquid onto the road will be seen differently than the glow of a "normal" house fire. Consequently, the two scenarios will meet with completely different reactions on the part of the persons responsible for coordinating the emergency response or making funds available for measures to improve working conditions and safety.
That being the case, it will take several years before “clean work habits” and sustained firefighter hygiene practices are normalized.
What, in your estimation, is the incidence of fire-related cancer in Germany?
That’s hard to say. According to government figures, cancer is still the number two cause of death here in Germany, second only to cardiovascular disease.
The German Centre for Cancer Registry Data at the Robert Koch Institute in Berlin collects and analyses data on cancer types, incidence, and treatments, etc., which it publishes every five years. Unfortunately, that information does not support any direct conclusions regarding fire service work as a causal or contributing factor. We urgently need that kind of information, so that we can confirm a direct link between the work done by our firefighters and elevated cancer risk. Sufferers may not be shouting their diagnosis from the rooftops or beating our door down, but we have anecdotal evidence of about 250 cases.
So that’s 250 people who have approached your organization?
Yes, that’s right. Our efforts to identify the scope of the problem are still wholly dependent on voluntary information from individual sufferers. And given that there are at least 1.2 million volunteer firefighters and about 55,000 professional, plant and other firefighting professionals in Germany, 250 seems to be on the low side. We’re fairly sure that if we had official figures, they would be higher. That’s why we urgently need a cancer register for front-line fire service personnel!
What is FeuerKrebs gUG’s mission, and how do you fund its activities?As a foundation for the advancement and sustained improvement of the health and working conditions of firefighters, we have set ourselves three main objectives.
In undertaking all of these initiatives and activities, we are reliant on donations. Unfortunately there is no government funding available for the work we do.
What sorts of responses have you had? Which organizations tend to be receptive? Which ones are more guarded?
It’s a mixed bag. We are often invited to give talks to fire brigades, present to executive workshops and committees and have input into plans for new fire stations. That means there is always someone at these organizations who has already engaged to some extent with the subject of fire-related cancer and has reached out to us to enlist our help in convincing their colleagues to do things differently. There are always skeptics, of course. But we encounter open doors almost everywhere we go, and the initial contact often leads to discussion on the implementation of potential new approaches. Sometimes we even receive good news regarding positive changes several weeks after our visit or presentation.
What countries can Germany learn from when it comes to occupational cancers in firefighting?
Canada. Canada was the first country in the world to adopt legislation on compensation. Since 2003, the country has legally recognized 17 types of cancers as occupational diseases, with recognition depending on the first-responder service to which the sufferer belongs.
In what way will you be presenting the issue of occupational cancers in the fire service at INTERSCHUTZ 2020? What are you hoping to achieve in Hannover?
Well, I don’t want to give away too much at this stage, but what I will say is that our objective will be to raise awareness of the need for sustained firefighter hygiene practices in the hope of changing ingrained habits and practices. At the same time, we will be looking for allies who can support us in this. We also want to use the show to achieve progress. We will be drawing attention to other occupational risks and hazards, sharing tips on prevention, and holding talks with people from all levels of the fire service. And we will be partnering with manufacturers of firefighting apparatus and equipment to find and present solutions for reducing cross-contamination.
One last question in closing: Has your involvement with the issue of occupational cancer in any way dampened your passion for your profession?
I have had a close association with the fire service for 40 years and I love being a fireman – it’s been like making a profession of a hobby. Our education workshops and presentations are about raising awareness, not spreading doom and gloom about the fire profession. So, despite knowing what I now know, I love being a fireman and would not choose any other career.
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