A Report From The SFFCPF

1. A Report From The SFFCPF San Francisco Firefighters Cancer Prevention Foundation

2. Established in 2006 • Supported by SFFD Administration and Local 798 • 501c3 status gained • Dedicated to the early detection and prevention of cancer in both active and retired firefighters • Cancer presumptive law SFFCPF Creation

3. Board of Directors formed • Bylaws established • Mission Statement created • Basic strategic plan established • Cancer questionnaire sent out to both active and retired firefighters SFFCPF Creation

4. Dr. Marshall Stoller, Assistant Chair Department of Urology, Dr. Kirsten Greene, Urologist U.C.S.F • NMP-22 screening (Nuclear Matrix Protein-22) • Hemastix • 1,286 active and retired firefighters UCSF Bladder Cancer Study

5. Mean age 45 • 93 positive for hematuria • 6 positive for NMP-22 • 1 positive for both hematuria and NMP-22 • Follow up with urine cytology and cystoscopy • 2 retired and 1 active diagnosed with T.C.C. Study Results

6. Age and sex- adjusted incidence for TCC of the bladder is 36 per 100,000 • TCC of the renal pelvis occurs in 1 in 100,000 • Study was presented at the Annual Scientific Meeting of the American Urological Association in 2008 • Study suggests that firefighters may be at a higher risk of developing TCC Comparative Statistic

7. The question was addressed by the foundation • Overhaul SOP's were in question • High rates of cancer in arson investigators • Department creates a committee to review and make changes in the SOP's • It goes nowhere How do we reduce toxic exposures?

8. Take at home test • 1,203 active and retired firefighters took part • F.I.T. kit and survey were mailed to those over 40 • Published in the Oxford Journals of Occupational Health (2014) 2008-2009 Fecal Immunochemical Test

9. 445 individuals (37%) completed the survey • 400 individuals (33%) completed the F.I.T. • 45% responded to having had a stool test at some time • Only 8% had had one in the last year • 36% had had a sigmoidoscopy at some time • Among those aged 50 and older, 59% had had a test for colon cancer at some time F.I.T. results

10. A workplace intervention can increase CRC screening rates in firefighters • Future studies should focus on the long term sustainability of this type of program F.I.T. conclusions

11. Conducted by researchers from NIOSH in collaboration with researches at the National Cancer Institute and Department of Public Health Sciences at U.C. Davis • Funding provided by NIOSH with supplemental funding from U.S. Fire Admin. • Study was done to better understand the potential link between firefighting and cancer. N.I.O.S.H. Study

12. 29,993 firefighters from San Francisco, Chicago and Philadelphia • Phase 1- Focus on those employed between 1950-2009 • Employment info collected for each firefighter The study cohort

13. Determine causes of death and cancer diagnoses from previous studies • The National Death Index • Death certificates • 11 state cancer registries The study cohort

14. Firefighters considered to be a healthier population • Firefighters had more cancer deaths and cancer cases than expected • Increases in digestive, oral, respiratory, and urinary cancers • Twice as many malignant mesothelioma cases than expected N.I.O.S.H. Study Findings

15. Higher rates of prostate and bladder cancers in firefighters less than 65 years of age • Increased bladder cancer mortality and incidence among women firefighters • Number of deaths from ALL causes of death did not differ from the expected number based on death rates in the general population • Number of deaths due to cancer in the SFFD from 2000-2009: 151 • Equaled 32% of the total deaths during this time N.I.O.S.H. Study Findings

16. Estimate the exposure potential of each study participant • Examine the relation between exposure and cancer risk • Follow the career of the firefighters who contracted cancer N.I.O.S.H. Study Phase 2

17. Exposure risks during overhaul • Toxic chemical cocktail • Concern rises over PBDE’s exposure Prevention Addressed Again

18. Flame retardant chemicals, a health hazard? • Persist in the environment • Accumulate in living organisms • Liver toxicity • Thyroid toxicity • Neurodevelopmental toxicity PBDE's

19. Off gas both furans and dioxins • Produce highly corrosive gas: hydrogen bromide • Bioaccumulate • Have the ability to permeate PPI (CDC 2008 study) PBDE's and Firefighters

20. 12 firefighters, 2 separate working fires • First study to measure brominated dioxins/furans • Dr. Susan Shaw, Dr. Kurunthachalam Kannan, Wadsworth Center, New York State Department of Health, Marine Environmental Research Institute of Maine PBDE Pilot Study

21. PBDE's were dominated by deca-BDE • Deca-dominated pattern is not found in the general population • Typical pattern found in blood of e-waste recyclers continuously exposed to deca-BDE from open burning of plastics Study Results

22. San Francisco firefighters showed levels of PBDE's 30% higher than general pop. of CA • 60% higher than the general pop. of the U.S. • 20 to 30 times higher than levels found in the general pop. of Japan (Uemura et.al. 2010), Hong Kong (Qin et.al. 2011) and the United Kingdom (Thomas et.al. 2006) • Negative aspects of the study Study Results

23. 2011 contacted by State Senator Mark Leno • Support SB 147 • TB 117 in place since 1975 • Very strong chemical lobby Advocates

24. 2012 contacted by U.S. Senator Boxer's office • Asked to give testimony supporting the “Safe Chemicals Act” • Appeared before the “Committee on Environment and Public Health • Reform of the 1976 “Toxic Substances Control Act” • Passes committee but dies on the Senate Floor Advocates

25. Search the web for studies that have taken place with women firefighters • Organize a general meeting and invite researchers from throughout the Bay Area to attend. • A committee is organized to finalize and confirm a list of committed researchers Breast Cancer Study

26. SFFCPF • United Fire Service Women • Silent Spring Institute • School of Public Health and the Department of Environmental Science, Policy and Management U.C. Berkeley • U.C.S.F. • $600,000 Grant from The California Breast Cancer Research Program Women Firefighters Biomonitoring Collaborative

27. 80 women from the SFFD. 80 women from other civil service positions. • Blood and urine samples collected • Looking for chemicals linked to breast cancer including products of combustion General Methodology

28. “Time of flight” technology a non-specific technique that scans the sample for chemicals based on their molecular weight • Thyroid hormones measured • Melatonin levels measured General Methodology

29. Developing safer SOP's during overhaul • Immediate gross decon • Does the culture change? • Firehouse toxic reductions program • Continue the role of Advocacy Prevention-Reducing Exposures

30. Diet/Nutrition • Micronutrients/Antioxidants • Isothiocyanates • Phytoflavinoids • Polyphenols • Curcuminoids • Beta Glucans • Vitamin D Levels • 25-Hydroxyvitamin D (50-70 ng/ml) • Rest Prevention- A Personal Stake

31. Changes in workers comp • 4 year latency period • No QME visit • A note from the treating physician confirming a diagnosis of cancer is all that is necessary • No changing of treating physicians • Legislation drawn up and supported by the Mayor for the city's retirement board to adopt the cancer presumption law for firefighters. • Greater Awareness The Outcome

32. Urine metabolite study in conjunction with UCSF, Dr. Marshall Stoller • Silicone wristband study in conjunction with Dr. Kim Anderson, Oregon State • Women's biomonitoring study...on-going • Longitudinal study • Continue researching for the latest medically approved screenings that we can utilize to catch cancer at its earliest stage. The Future