Focus on Fitness 2012: An ounce of prevention

In the 18th century, research by Dr. Percivall Pott convinced the British Parliament to pass the Chimney Sweepers Act of 1788 to protect children from exploitation and job-related cancers associated with exposure to smoke, soot and tar while cleaning chimneys.

More than two centuries later, most Canadian provinces have recognized that firefighters face a similar occupational hazard and have instituted presumptive legislation to help the families of firefighters who die from certain cancers. But, as with fire prevention, cancer prevention is an area that needs more attention and a British Columbia doctor is working to help the fire service institute earlier screening and cancer-prevention programs.

Dr. Kenneth Kunz, an oncologist, cancer consultant and researcher, is campaigning for both greater recognition of job-related cancers in firefighters and more cancer prevention mechanisms.

Kunz started investigating job-related cancer in firefighters in the spring of 2011 when he was living in Nelson, B.C. At the time, a local fire department asked him to speak on the topic as part of a cancer lecture series he was offering in the community.

The more Kunz delved into the issue, the more he appreciated the risks to firefighters. For example, after reading a publication in the September 2011 edition of the Lancet medical journal about a wide variety of firefighter cancers resulting from the 9-11 World Trade Center disaster, Kunz realized that even a house fire emits a complex mixture of toxic chemicals. He also believes that turnout gear should be improved to offer greater protection to firefighters.

“A year ago we had an apartment block burn down here in Nelson,” Kunz said in an interview. “A firefighter friend told me his wife mentioned that he smelled like a smoked ham for 10 days after the blaze. Those are carcinogens that had found their way into his body and were slowly being excreted.

“I asked him if he wore his turnout gear appropriately, including positive pressure breathing apparatus, gloves and balaclava. Yes, he did. It occurred to me that even if you wear your equipment properly, carcinogens get into your body. They’re aerosolized and find ways in.”

The carcinogens lodge in the body’s fat cells and are slowly released as they are metabolized. That’s why firefighters are at risk of all types of cancers, Kunz said.

“The more research I did, the more I realized there was this vast unmet need. Firefighters started coming up to me and saying, ‘One of my partners died of leukemia.’ Another firefighter came up to me and said, ‘I’m battling lymphoma.’ And another firefighter, after undergoing surgery and chemotherapy, described his narrow escape from a death at the hands of esophageal cancer. These were just a few examples.”

To help firefighters establish proper cancer screening and surveillance programs, Kunz developed a letter firefighters can bring to their family doctors that explains the specific cancer risks to firefighters. The letter can be downloaded at the Fire Chiefs’ Association of British Columbia (FCABC) website, www.fcabc.bc.ca .

After consulting with other medical experts in the field, Kunz advocates that firefighters should start being screened for cancer 10 years earlier than the usually recommended age – just like people with a close family member who has had cancer. Kunz also recommends that doctors be on the lookout for all types of cancers, instead of only the ones identified by legislation.

“A thorough and regular screening program is more likely to detect a cancer early, when there is a higher chance of effective treatment,” he said. “Once cancer is advanced and has spread through the body, it’s like a fire where flames engulf the house. There is less of a chance of effective intervention.”

Dr. Louis Francescutti, president of the Royal College of Physicians and Surgeons, said in an interview that earlier screening of firefighters for cancer makes sense from a prevention standpoint.

“Physicians who treat firefighters should make themselves aware of the increased risks faced by this particular patient group,” Francescutti said.

“More preventative screening will lessen the impact of the health risks faced by firefighters.”

Kunz’s campaign has been gaining support within British Columbia’s fire community, from both union and management organizations. Groups such as the FCABC and the British Columbia Professional Fire Fighters’ Association have invited Kunz to make presentations, while the Surrey firefighters’ union local co-funded the development of Kunz’s letter to doctors with the City of Surrey out of their joint health and wellness fund.

“It was important to representatives of both the International Association of Firefighters Local 1271 and the fire chiefs association that we spearhead this issue that affects all firefighters,” said IAFF Local 1271 President Mike McNamara. “Prevention is our key objective. This initiative will save lives.”

Firefighters must learn to become advocates for their own health, Kunz said. For many, that’s a new and uncomfortable role, given the traditional culture surrounding the fire service.

“We have this image of firefighters as heroes who don’t require help,” he said. “It’s not like they are getting cancer because they are lying around all day smoking cigarettes and eating high-fat diets with food preservatives. They’re getting cancer simply by trying to earn a living by protecting the public, and it seems we aren’t protecting the people we expect to protect us: the firefighters. They’re in the business to help people and they are dying of cancer on account of it.”

Kunz’s advice for firefighters who want to reduce their risk of cancer includes:

• Minimize contact with carcinogens – always wear turnout gear appropriately and ensure it is in good repair.
• Take care of yourself – exercise, eat healthy foods and don’t smoke.
• Print out the letter posted at www.fcabc.bc.ca and bring it to your doctor.
• Get routine checkups with a family doctor who knows you and is aware of the cancer risks to firefighters. Establish an annual health maintenance program that includes baseline cancer screening and surveillance.

Now that Kunz has become aware of the risks of cancer faced by firefighters, he feels compelled to join others and spread the word within the medical and firefighting communities. He is also advocating the creation of a national organization dedicated to ensuring that cancer presumption laws across Canada are consistent and comprehensive.

“We know that cancer is a natural consequence of living,” Kunz says. “The fossil records show that even dinosaurs died of cancer. But we can save lives if we consider changing to healthier lifestyles and start cancer screening to catch it an earlier stage. I’m looking to join others in helping to reduce the number of widows and bagpipe ceremonies.”  

Firefighters face statistically significant higher risks of getting cancer than the general population. Although the risk is difficult to measure because individual exposures vary, published studies show the increased risk of cancer in firefighters can range from 1.3 times for prostate cancer, to 5.2 times for cervical cancer in female firefighters, to as much as 36 times for kidney cancer in firefighters with 40 or more years of service.

This increased risk is due to repeated and intense exposure to complex mixtures of concentrated carcinogens found in smoke, soot and tar. These toxins can be inhaled, absorbed through the skin or inadvertently ingested.

In Canada, legislation covering occupational cancers for firefighters was initially championed by Manitoba in 2002 before being adopted in other jurisdictions. Coverage varies from province to province, typically addresses only a prescribed number of cancers (for example, just 10 in B.C.), and imposes time limits – esophageal cancer, for instance, is covered in Ontario only after 25 years on the job. Newfoundland and Labrador have no legislation at all.

“The cancer presumption laws are a good start but they’re not consistent or comprehensive enough, Canada-wide,” Kunz says. Studies show that firefighters can get any kind of cancer, and they can get it any time, as cancer does not obey the stipulated minimum cumulative periods.

“There are over 200 types of cancer. Because the carcinogens are dissolved through their systems, firefighters are likely at an increased risk of getting any of these types of cancer.”

Kunz may be contacted at kenn@netidea.com.

Len Garis is fire chief for the City of Surrey, B.C., and an adjunct professor in the School of Criminology and Criminal Justice at the University of the Fraser Valley and a member of the Institute of Canadian Urban Research Studies, Simon Fraser University. Contact him at lwgaris@surrey.ca
Karin Mark is a former newspaper reporter who writes for publications and corporate clients in Greater Vancouver, B.C.