Firefighter at a scene with a lot of smoke

Fire Protection Research Foundation publishes a literature review report on firefighter exposure to fireground carcinogens

Fireground Exposure of Firefighters: A Literature ReviewThe Fire Protection Research Foundation (FPRF), the research affiliate of NFPA, recently published a comprehensive literature review research report on the “Fireground Exposure of Firefighters.” The objective of the project was to assimilate the existing peer reviewed literature into a framework to understand the matrix of carcinogen exposure risks that firefighters face while performing their job tasks on the fireground. This examination focused specifically on carcinogenic exposure on the fireground, and the final report from this study can be found on the FPRF website.

Research on the epidemiologic relationship between cancer and firefighting has been a focus of several recent cohorts and meta-analytic studies in the last decade. While the overall cancer risk among firefighters is estimated to be around 9-14% higher, as compared to the general population, the increased risk for individual cancers is often much higher and firefighters have been found to develop cancer at a younger age than the general population. Ongoing long-term efforts such as the prospective multicenter Fire Fighter Cancer Cohort Study ( and the National Firefighter Registry (NIOSH, 2020) dive deeper into the  relationships between exposure and risk with more detail. Beyond cancer, exposure on the fireground has also spurred other health implications including cardiovascular, respiratory, and reproductive challenges for both female and male firefighters.

A wide variety of exposure studies have been published in the last decade with many examining known and suspected carcinogens present on the fireground. Studies vary significantly in terms of data collection methods (e.g., biological sampling, active or passive air sampling, personal sampling devices such as a silicone dosimeter), type of incident (e.g., wildland fire, room and contents fire, training, vehicle fire, hazmat incident), and locations. Some look at regional differences as building materials vary both by locale and time of construction (e.g., legacy vs. modern construction). Understanding the nuances of exposures and risk in the literature will help to inform prevention and intervention efforts for firefighters.

Given the significant growth in research on this topic, FPRF contractedthe Centre for Fire, Rescue, & EMS Health Research, NDRI Ventures, led by Dr. Sara Jahnke and her team, to conduct a systematic review of existing literature. The objective was to outline the current state of the science, summarize the findings, and identify gaps in the literature. A total of 75 articles (with about 68% being conducted in the last decade) were finally identified in the analysis. This number was arrived at after screening a larger number of articles using the inclusion criteria established for this project scope. Eligible articles included: any peer-reviewed published journal article that reported specific chemicals (or groups of chemicals) in body fluids (blood, urine, semen, and breastmilk) or monitored in the air attributed to fire smoke exposure. Only carcinogenic chemical exposures specific to the fireground were included. Each study reviewed had one set of study level variables that were applied and tabulated to both biomonitoring and environmental monitoring. Within each category, tables are grouped by International Agency for Research on Cancer (IARC) chemical classification. Group 1 chemicals are defined by IARC as “carcinogenic to humans.” Group 2A are “probably carcinogenic to humans”. Group 2B are “possibly carcinogenic to humans” and Group 3 are “not classifiable as to their carcinogenicity to humans.”

For biomonitoring studies, significant gaps were identified for fire instructors, fire investigators, aircraft rescue and firefighting (ARFF) firefighters, industrial firefighters, and recruits. It was also noted that future research should focus on examining the impact of the changing fire environment as the products of combustion in fires have evolved over the years. The gap analysis identified several areas of needed research within environmental monitoring including studies of carcinogens through wildland fires, exposures through electrical/transformer fires, ARFF exposures, and training fires. Additional research by type of data collection such as through gear samples and passive sampling devices was also identified as a need. Finally, it was determined that additional research on major events is needed through real-time environmental monitoring.

This project report provides a strong foundation for the ongoing work that is being done to understand what firefighters are exposed to on the fireground.  It will serve as a valuable resource as IARC reevaluates the risks of firefighting, for groups fighting for cancer presumption, and for researchers identifying gaps in the literature.

Clearly, the fireground, by its very nature, is a high-risk environment with a number of carcinogenic exposures for any responder on the scene. Understanding these risks is an important foundation for understanding health and environmental impacts and for identifying and promoting mitigation and prevention efforts.

Sign up for the NFPA Network Newsletter
Sreenivasan Ranganathan
Director, Research Foundation, Mission to plan, manage and communicate research in support of the NFPA mission

Related Articles