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IAFC Disputes Study on Firefighter Cancer Presumption Laws

The International Association of Fire Chiefs took aim Wednesday at a study prepared for the National League of Cities that analyzed the science behind laws in 24 states that have a cancer presumption benefit for firefighters. The report, titled "Assessing State Firefighter Cancer Presumption Laws And Current Firefighter Cancer Research," found there is inadequate scientific research to determine a link between working as a firefighter and an elevated risk of contracting cancer, but the IAFC Safety, Health and Survival Section convened an expert panel that now is questioning how that conclusion was reached.

Four researchers from the TriData Division of System Planning Corporation in Arlington, Va., conducted the study and wrote the report. It notes studies have found supporting associations between firefighting and bladder, colon, Hodgkin's lymphoma, kidney, malignant melanoma, multiple myeloma, non-Hodgkin's lymphoma, prostate, testicular, thyroid, and ureter cancers, but said: "The researchers found that considerable research needs to be undertaken before definitive linkages can be supported or refuted."

"If the National League of Cities is truly concerned about evaluating that issue 'objectively and scientifically' as they stated in their press release, then they need to look at all the data in a scientifically sound manner," IAFC President Chief Larry Grorud said. "Data-based research is one of our strongest allies in reducing firefighter deaths, injuries, and disease, but not if we frame the questions or manipulate the data with an end result already in mind. Rather than ignoring it, we ought to be looking closely at the ample data that does indicate a link between firefighting and cancer and how that data may support prevention. Future investments in research need to be forward-focused on preventing firefighter illness and deaths. This report offers the men and women of the fire service no path forward."

The authors of the report cited weaknesses in the literature that include an "extremely small" number of studies investigating firefighting as a potential risk factor in cancer, when compared with the overall volume of cancer research conducted annually in the United States. Firefighter cancer incidence rates are lacking in the literature, which limits accurate analyses, and the researchers could identify no experts in cancer presumption. Existing presumption laws vary greatly in which cancer types they cover. Patients in studies were lost to follow-up, making long-term outcomes difficult to determine, and studies did not take into account career/volunteer status or suburban/rural firefighter status, they wrote.

Their review looked at relevant documents published between 1995 and 2008, with 71 found to address firefighters and cancer. Seventeen of the 71 identified firefighting as a possible cancer risk, but of the 35 cancer types identified in those 17 studies, 10 strong associations were found between firefighting and cancer -- as were 15 moderate associations, 23 weak associations, 185 no associations, and 1 unable to establish an association.

IAFC's panel said the report's authors " 'hand select' which articles to review and rely on narrative methods to draw their conclusions." Narrative reviews are particularly prone to bias and infeior to quantitative review methods, the panel noted. The NLC report excluded a number of studies with large, statistically significant associations between firefighting and various cancers that were included in a 2006 study by LeMaster et al., the panel said.

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