Study Fails to Establish Link Between Cancer and Firefighting

Overall, the researchers from TriData Corporation, a division of System Planning Corporation, concluded that there is a lack of substantive scientific evidence currently available to confirm linkages between firefighting and an elevated incidence of cancer. Click here for the full study.

A critical part of the study was the investigation of published information involving firefighters and cancers that have been diagnosed in the firefighter population. Of the thousands of cancer studies conducted during 1995-2008, only 17 studies looked at firefighting as a possible risk factor for cancer and were deemed substantial research reports.

Although several studies found supporting associations between firefighting and bladder, brain, colon, Hodgkin’s lymphoma, kidney, malignant melanoma, multiple myeloma, Non-Hodgkin’s lymphoma, prostate, testicular, thyroid, and ureter cancers, others are not supportive of the same supposition. Due to the inconsistency between studies regarding the establishment of associations and the strength of established associations, the research team could not support or refute firefighting as a cause of cancer for firefighters.

Forty-three states have enacted laws that allow firefighters and emergency medical services (EMS) providers who develop certain injuries, illnesses, and diseases to qualify for workers’ compensation and certain other benefits under a presumption that the injuries, illnesses, and diseases are work-related. Cancer is one of the diseases covered in 24 state presumption laws. Eight other states have pending cancer presumption legislation and more are expected.

“While we depend on firefighters for the critical role they play in the safety of our cities and towns, we must evaluate this issue objectively and scientifically,” said NLC Executive Director Donald J. Borut. “This study demonstrates the need for more high-level research into cancer and firefighters. States should not pass laws requiring cities to take on difficult financial burdens with no clear scientific connection between illness and occupation. We suggest that all involved — legislators, governors, cities and firefighters — review this report and consider its findings as they discuss this difficult issue.”

Presumption is a concept that assumes that certain injuries, illnesses, or diseases are a consequence of work and are compensable without evidence provided by the employee that the affliction is work-related. Normally, employees must prove that their injuries, illnesses, or diseases are caused by the work or workplace conditions.

Employers may be able to dispute (rebut) a presumption claim and deny benefits under the workers’ compensation program if the law creates a rebuttable presumption. However, the employer must prove that the injury, illness or disease could not have resulted from work — a standard that is, at best, very difficult to meet. The passage of a state presumption statute could result in cities and towns paying for workers’ compensation benefits for employees and others who may have developed cancer irrespective of their employment as firefighters. 

Bills were recently introduced in the U.S. House and Senate, the Federal Firefighters Fairness Act of 2009, to create a presumption that the disability or death of a federal employee in fire protection activities caused by certain diseases is the result of the performance of the employee’s duty. Thirteen cancers are enumerated and the Secretary of Labor may add other cancers if it is determined that they are related to hazards associated with fire protection.

Sen. Susan Collins (R-Maine), a sponsor of the Senate bill, says, “It is fundamentally unfair that firefighters employed by the federal government are not eligible for disability retirement for the same occupational diseases as their municipal counterparts. This disparity is especially glaring in instances where federal firefighters work along side municipal firefighters during mutual aid responses and are exposed to the same hazardous conditions, as was the case in the response to Hurricane Katrina.”

The TriData study examines the many issues that influence perceptions of and reactions to firefighter cancer presumptions that need to be considered when dealing with the enactment of legislation and the consequences of creating presumption laws. These are social issues about the firefighting profession, questions about predispositions to occupational diseases, the impact of technological improvements to protective equipment, the costs of presumption for employers, issues about the fairness of not covering other employees exposed to similar hazards, and the influence of political pressure rather than scientific validity or financial stewardship in the development of state policy. The report also analyzes specific provisions in the state laws such as eligible personnel, age limits, minimum service requirements, and post employment eligibility.

While there is some implied statistical increase in cancer in a few studies, no studies indicated that cancer appeared at an alarmingly higher rate in firefighters than in the general population. A particularly interesting finding of the research is the inconsistency with respect to the cancers covered in state laws and the scientific evidence currently available. Leukemia, which is included in seven state laws, was included in 10 studies — one showed a weak association between firefighting and the disease and nine others found no association.

The cancer research studies do, however, provide solid groundwork from which future studies can be developed and improved.  The researchers recommend collaborative efforts by government, scientists, firefighters, municipalities, national associations, and others to undertake additional research, establish a firefighter cancer database, and seek more federal funding for research. A noteworthy provision in the new federal presumption bill is a requirement for the Centers for Disease Control and Prevention to examine appropriate scientific and medical data related to the health risks associated with firefighting.

One of the greatest concerns for municipal employers is the financial impact of state mandated presumptions. Cost estimates are not available due to the lack of data but there are reasons to be concerned about the impact.  And, since the completion of the study, another cost driver has been identified.

The majority of cancers detected today occur after the age of Medicare eligibility and the cost is born broadly across the Medicare system. Under the concept of presumption, Medicare has a right given its status as a secondary payer to demand that workers’ compensation policies pick up 100 percent of this lifetime cost in states that have not limited the post-employment eligibility period. This would place substantial additional costs on municipal employers and could lead to a lack of availability of the private market for workers’ compensation insurance for firefighters.