Document Type: Systematic Review and Meta-analysis
United Arab Emirates University, College of Medicine and Health Sciences, Institute of Public Health, Al Ain, United Arab Emirates.
Harvard T.H. Chan School of Public Health, Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology (EOME), Boston, MA, USA.
Keimyung University, College of Medicine, Department of Preventive Medicine, Daegu, Korea.
Cyprus University of Technology, School of Health Sciences, Cyprus International Institute for Environmental and Public Health in association with Harvard School of Public Health, Limassol, Cyprus.
The Biostatistics Center, The George Washington University, Rockville, MD, USA.
Cambridge Health Alliance, Employee & Industrial Medicine, Cambridge, MA, USA.
Objective: A systematic literature review and meta-analysis was conducted on the association between firefighting and cancer. Methods: A comprehensive literature search of databases including Medline, EMBASE, Biosis, NIOSHTIC2, Web of Science, Cancerlit, and HealthStar, for the period between 1966 to January 2007, was conducted. We also retrieved additional studies by manual searching. Results: A total of 49 studies were included in the meta-analysis. We found statistically significant associations between firefighting and cancers of bladder, brain and CNS, and colorectal cancers, consistent with several previous risk estimates. We also found statistically significant associations of firefighting with non-Hodgkin’s lymphoma, skin melanoma, prostate, and testicular cancer. For kidney, Hodgkin’s lymphoma, leukemia, lymphosarcoma and reticulosarcoma, multiple myeloma, and pancreatic cancer, we found some statistically significant but less consistent results. For all other cancers evaluated (esophageal, laryngeal, oral and pharyngeal, liver and gallbladder, lung, lymphatic and hematopoietic, non-melanoma skin cancer, stomach, and urinary cancer) we did not find any statistically significant associations. Conclusions: Although our meta-analysis showed statistically significant increased risks of either cancer incidence or mortality of certain cancers in association with firefighting, a number of important limitations of the underlying studies exist, which, precluded our ability to arrive at definitive conclusions regarding causation.