What Firefighters Must Know About Bladder Cancer
If detected in its earliest stages, bladder cancer is a highly treatable cancer. The five-year survival rate is nearly 95 percent2 if you receive a bladder cancer diagnosis while the cancer is still in the lining of the bladder. Conversely, the five-year survival rate is less than 10 percent2 when diagnosed in a more advanced stage.
Fortunately, modern technology now allows for inexpensive, simple and noninvasive testing, including the bladder cancer urine tests available from Cxbladder15. This news is especially welcome in firefighters, who have increased bladder cancer risks.
You may not know bladder cancer is almost as common as colon cancer in men2. Its recurrence rate is one of the highest of any cancer2, including skin cancer. In the U.S., it comes second to the most common cancer — prostate cancer — as a urologic malignancy. It even has a higher prevalence rate than lung cancer. Today, over a half-million individuals2 are living with or have had bladder cancer.
Out of all occupational groups, firefighters are among the most susceptible to bladder cancer. And, because of this, it's a surprise many doctors and firefighters aren't aware of this firefighter bladder cancer risk.
Why Firefighters Are at a Higher Risk of Bladder Cancer
Prolonged exposure to environmental chemicals and pollutants can hinder occupational safety and increase your risk for bladder cancer1, according to a news release published by the American Urology Association covering a study conducted by researchers from the University of California, San Francisco.
As your body absorbs the cancer-causing chemicals, they get:
- Transported to your blood
- Filtered out by your kidneys
- Eliminated from your body through your urine
High chemical concentrations in urine can damage your bladder's endothelial lining, giving you a higher risk of cancer.
Bladder Cancer Studies Conducted on Firefighters
Since firefighters get exposed to smoke and chemical fumes regularly, they could have a higher risk of bladder cancer. Various studies and research support this, including the ones cited below.
1. Screening Study of San Francisco Firefighters
In this study, researchers evaluated 1,286 retired and active firefighters in San Francisco1 to explore the possibility of increased bladder cancer risks. The subjects of the study participated in voluntary testing between August 2006 and March 2007.
Ninety-nine of the subjects were referred on for additional testing which consisted of cystoscopy, upper tract imaging and urine cytology. Of the group, two retired firefighters received a bladder cancer diagnosis. These findings represent a higher incidence than the expected age and sex adjusted rate of 36 per 100,000, which suggests retired firefighters could be a high-risk group.
2. Multi-Year Study
The National Institute for Occupational Safety and Health (NIOSH) began a multi-year study in 2010 of almost 30,000 firefighters7 from the Philadelphia, San Francisco and Chicago fire departments to get a better understanding of the possible association between cancer and firefighting.
Researchers at NIOSH collaborated with researchers from the University of California at Davis Department of Public Health Sciences and the National Cancer Institute in a joint effort to lead the study, which the U.S. Fire Administration also partially supported. The studied firefighters showed higher rates of specific types of cancer than the general United States population. Particular findings include:
- Around twice the number of firefighters have malignant mesothelioma, a rare form of cancer linked with asbestos exposure. Asbestos exposure while fighting fires is the most probable explanation for this.
- The studied firefighters have a higher number of cancer diagnoses and deaths. These cancers were mainly oral, digestive, urinary and respiratory cancers.
- Younger firefighters made up more cases of certain types of cancers. For instance, the studied firefighters under age 65 had more prostate and bladder cancers than expected.
- When researchers compared firefighters with each other in the study, the risk of receiving a lung cancer diagnosis or lung cancer-related death increased with the amount of time they spent fighting fires. The risk of leukemia-related death also went up with the number of runs to fires.
The NIOSH study offers additional evidence firefighters have a higher risk of certain forms of cancer due to occupational exposure. Increased awareness and prevention efforts are cost-effective ways of reducing occupational cancer risk. So, fire services should increase their efforts to promote bladder cancer facts for firefighters. They should also educate members on safe work-related practices, including correct use of protective clothing, proper training and correct use of respiratory protection during all firefighting phases.
3. Blais University of Ottawa Study
Researchers in this 2017 study found firefighters had absorbed harmful chemicals such as polycyclic aromatic hydrocarbons (PAH) through their skin. When comparing their urine before and after fighting the fire, the firefighters had up to more than five times the amount of PAH byproducts16 in their urine than before the fire. PAHs release from burning wood, trash, gasoline, oil, coal and tobacco.
Factors that Contribute to the Risk of Developing Bladder Cancer
What firefighters must know about bladder cancer includes the factors that contribute to their higher risk of developing the disease17, including those below.
1. Firefighters' Exposure to Potential Carcinogens
Firefighters get exposed to carcinogenic toxins not when they're in the building that is on fire, but rather when they're close to it. Firefighters risk exposure to many carcinogens, which include:
- Diesel engine exhaust
- Heavy metals
Chemicals used in the rubber, textile, dye, print and paint industries also may increase the chances of developing bladder cancer, as can aromatic amines and some naturally occurring chemicals.
Exposure occurs both when firefighters inhale these chemicals and absorb them through their skin.
2. Tobacco Use
Cigarette smoking is the most common risk factor17, although smoking pipes and cigars may also increase the risk of bladder cancer development. Smokers are four to seven times more likely to develop bladder cancer than individuals who don't smoke.
Men are three to four times more likely17 to develop bladder cancer than women. However, women have a higher risk of dying from this cancer than men.
The likelihood of receiving a bladder cancer diagnosis increases with age. Over 70 percent of individuals17 with bladder cancer are older than 65.
White/Caucasian individuals are more than twice as likely to receive17 a bladder cancer diagnosis as African-Americans. However, Black individuals have twice as much of a risk of dying from the disease.
6. Cyclophosphamide Use
Individuals who've had chemo with cyclophosphamide have a higher chance of bladder cancer development.
7. Chronic Bladder Problems
Bladder infections and stones could increase a firefighter's bladder cancer risk. Bladder cancer might be more common for individuals who are paralyzed from the waist down, require a urinary catheter and have had numerous urinary infections.
8. Health History
Individuals who have already had this type of cancer once have a higher chance of developing it again.
In the year 2011, the FDA warned that individuals who've taken the drug pioglitazone17 for diabetes for over a year could have a higher risk of bladder cancer development. However, there have been contradictory results in published studies.
Individuals who have some types of this parasitic condition, which comes from parts of South America, Africa, the Middle East and Southeast Asia, have a higher risk of getting squamous cell bladder cancer.
11. Arsenic Exposure
Arsenic can cause health issues if people consume it in large amounts. This naturally occurring substance can also appear in drinking water and links with a higher risk of bladder cancer. Your chance of arsenic exposure depends on where you reside and whether you get your water from a public system that meets acceptable arsenic level standards or from a well.
12. Lynch Syndrome
Individuals who have an inherited condition known as Lynch syndrome, previously called hereditary nonpolyposis colorectal cancer, might have a higher risk of bladder cancer development.
Are Warning Signs of Bladder Cancer More Noticeable in Firefighters?
As mentioned earlier, firefighters have a higher risk of bladder cancer than other occupational groups. However, they might not be aware of their cancer risk or don't realize what the warning signs are. Men often get screened for colon and prostate cancers, and they know they're also not immune to developing lung cancer when exposed to tobacco smoke or if they smoke themselves.
Therefore, they watch for the signs of these cancers, including skin cancers. Bladder cancer, however, isn't a disease that is on most people's watch list — even firefighters. Therefore, firefighters often develop bladder cancer and remain unaware they have it.
Bladder Cancer Warning Signs
Firefighters with bladder cancer can help increase their rates of long-term survival by receiving an early diagnosis of the disease. For them to do this, however, they must be aware of the warning signs.
The first and most common sign of bladder cancer is hematuria, or blood in your urine14. In some cases, the urine will look normal, and only a test can detect the blood. While hematuria is one of the most telltale bladder cancer signs, there are other reasons why an individual would have hematuria, such as kidney stones and urinary tract infections.
Other warning signs of bladder cancer could include:
- An increased frequency of urination
- Painful urination
- Chronic bladder inflammation due to recurrent urinary tract infections
- Feeling a need to urinate but can't do so
Although each of these signs could have benign causes, individuals should not exclude bladder cancer, particularly those at a higher risk — like firefighters.
Precautions Firefighters Should Take
The following are steps you can take to reduce your risk of developing bladder cancer as a firefighter.
- When fighting fires, take precautions by always wearing protective self-contained breathing apparatus and clothing to shield you from chemicals and heat. Wearing protective equipment doesn’t eliminate the risk11 of developing bladder cancer, however.
- After fighting fires, use baby wipes or hand wipes to remove as much soot as possible from your hands, face, head, underarms, throat, jaw and neck before leaving the scene of the fire.
- Shower thoroughly when finished fighting the fire.
- Change your clothes, gloves, helmet and hood immediately after a fire.
- Wash not only your protective outerwear clothing after each firefighter incident, but also the clothing you were wearing underneath. For full decontamination, ensure you wash with a neutralizing carcinogenic detergent, such as D7 Laundry Sanitizer.
- Avoid placing contaminated clothes in your vehicle or taking them to your home.
- Have a minimum of two full sets of protective clothing and hoods, so that you always have a decontaminated set to wear.
How Often Should Firefighters Get Screened for Bladder Cancer?
Currently, no occupational health standards or routine screening guidelines exist for bladder cancer. Firefighters should work with their physicians to develop a plan for regular screenings for bladder cancer, taking into account all their risk factors.
Contact Cxbladder to Learn More About Our Non-Invasive Urine Tests for Bladder Cancer
Cxbladder is a suite of urine-based, non-invasive lab tests that rapidly and correctly detect and diagnose bladder cancer. It works by measuring the gene expression levels of five biomarkers that represent a bladder cancer signature. Since firefighters are at an elevated risk of developing bladder cancer, they can talk to their physician about the benefits of undergoing regular non-invasive urine-based bladder cancer testing.
Contact Cxbladder18 to learn about our non-invasive bladder cancer urine tests, and how Cxbladder can detect bladder cancer while still in the early stages and highly treatable.