National Firefighter Registry

A firefighter exits a burning building

Firefighter using a water hose on fire truck to extinguish a portion of a forest fire

A firefighter moving through a bush fire

Cancer risk in the U.S. fire service is a topic of growing concern. Recent studies suggest that exposure on the fireground may increase risk to firefighters of certain types of cancer and other chronic diseases.[2][3][4][5][6][7][8][9][10][11] Major international studies generally support findings from U.S. studies that firefighters experience increased rates of cancer, with some variation by cancer site.[12][13][14][15][16][17][18][19][20]

Firefighters regularly encounter carcinogenic materials and hazardous contaminants, which is thought to contribute to their excess cancer risk. Dozens of chemicals classified by the International Agency for Research on Cancer (IARC) as known or probable carcinogens have been identified on the fireground.[1][21] Several studies have documented airborne and/or dermal exposures to carcinogenic compounds during firefighting, as well as contamination on turnout gear and other equipment worn by firefighters.[22][23][24][25][26]  Some of these compounds have been shown to absorb into firefighters’ bodies.[27][28]

In addition to chemical exposures, firefighters also often work 24-hour or longer shifts; they also respond to emergencies and work shifts at night. Night shift work has been classified by IARC as a probable human carcinogen factor.[29] Some firefighters also work with hazardous materials and are trained to control and clean up dangerous materials such as oil spills and chemical accidents. As firefighters combat a fire and clean up hazardous materials, they risk harmful chemicals contacting their skin or penetrating their personal protective equipment (PPE).[20] In June 2022, IARC classified occupational exposure as a firefighter as “carcinogenic to humans.”[30]

There are many types of firefighters. Most research on firefighters’ cancer risk has involved structural or municipal career firefighters. Wildland firefighters are specially trained firefighters tasked with controlling forest fires. They frequently create fire lines, which are swathes of cut-down trees and dug-up grass placed in the path of the fire. This is designed to deprive the fire of fuel. Wildland firefighting is a physically demanding job with many acute hazards. Wildland firefighters may hike several miles while carrying heavy equipment during the wildfire season, which has increased in duration over time, especially in the western United States. Unlike structural firefighters, wildland firefighters typically do not wear respiratory protection, and may inhale particulate and other compounds emitted by the wildfires. They also use prescribed fires to burn potential fire fuel under controlled conditions.[31] To examine cancer risk for wildland firefighters, a risk assessment was conducted using an exposure-response relationship for risk of lung cancer mortality and measured particulate matter exposure from smoke at wildfires. This study concluded that wildland firefighters could have an increased risk of lung cancer mortality.[32] When not on the scene of an emergency, firefighters remain on call at fire stations, where they eat, sleep, and perform other duties during their shifts. Hence, sleep disruption is another occupational hazard that they may encounter at their job.[25]

The research on cancer for other subspecialty groups of firefighters is limited, but a recent study of fire instructors in Australia found an exposure-response relationship between training exposures and cancer incidence.[33]

In addition to epidemiological studies, mechanistic studies have used biomarkers to investigate exposures' effects on biological changes that could be related to cancer development. Several of these studies have found evidence of DNA damage, oxidative stress, and epigenetic changes related to firefighters' exposures.[34][35][36][37][38][39][40]

The proposed approach for the NFR states it will be a "surveillance system" of U.S. firefighters over the age of 18 years. The main goal of the NFR, according to the text of the law, is "to develop and maintain…a voluntary registry of firefighters to collect relevant health and occupational information of such firefighters for purposes of determining cancer incidence."[68][69] According to the Republican Policy Committee's summary, the NFR aims to provide decision makers with data to help them create new protocols to protect firefighters.[62] It aims to register around 200,000 firefighters across a variety of demographics within 5 years.[68] NIOSH plans to recruit firefighters through various communication channels (e.g., NFR website and newsletter, social media, local/state/national unions, affinity groups, trade journals, conference attendees) or directly from selected rosters of firefighters.[68][70]

Participation in the NFR is entirely voluntary and is open to all firefighters, including retired ones. Firefighters who register will provide their name, date of birth, and information about their lifestyle and exposures. Following this participants may be given voluntary yearly questionnaires.[70] NIOSH can then use this information to track past and future diagnoses of cancer among NFR participants by matching with data from state cancer registries to understand how firefighters’ work impacts their risk of developing cancer.[68][70]

Cancer is a nationally notifiable condition, and thus all U.S. states track diagnoses of cancer in a state cancer registry.[71] The NFR is planned to also seek additional details about participant’s types of emergency responses attended and exposures by working with fire departments and exposure tracking programs (if applicable), and by administering follow-up questionnaires to registered firefighters. Because cancer has a long latency period – which is the time between exposure to carcinogens and the development of cancer – the NFR will monitor cancer outcomes for decades.[68][70]