Firefighters & Bladder Cancer
Prolonged exposure to burning debris increases your risk
By Dr. Barry Stein
Forward by Michael Dubron


Firefighters are at higher risk for certain kinds of cancer—that’s an established fact. But many firefighters still lack information about specific risks—and what they can do to protect themselves.

One cancer that firefighters may not realize they have a higher risk for is bladder cancer. We understand the importance of wearing proper protective equipment (PPE) during fire attack, but we must stress the importance of continued use of our PPE during all phases of firefighting, including overhaul, because it’s this long-term exposure to the products of complete and incomplete combustion that increases the risk for bladder cancer.

The following excerpt from Dr. Barry Stein’s article “What Firefighters Should Know About Bladder Cancer,” emphasizes the vigilance that is needed. Some fire departments have begun bladder cancer testing programs using an NMP22 worksite urine test. Currently, the San Francisco Fire Department is providing free bladder cancer screening to its retirees and active firefighters with this test.

As a cancer survivor and active career firefighter, I am even more diligently aware of cancer symptoms and its potential recurrence. I urge you to learn more about this and other cancers that we are at risk for. The Firefighter Cancer Support Network can provide you and your family information and support. Educate yourself and even your physician.

—Michael Dubron, President, Firefighter Cancer Support Network


What Firefighters Should Know About Bladder Cancer
By Barry Stein, MD

Firefighters are among the most prominent occupational groups at increased risk for bladder cancer. Surprisingly, many firefighters and their physicians are unaware of their risk for this cancer. Men get screened for prostate and colon cancers; they understand that they’re not immune from lung cancer if they smoke or are exposed to tobacco smoke; and they watch for signs of skin cancer. Yet one of the most deadly cancers is not on their cancer watch list.

Bladder Cancer Facts
Bladder cancer is one of the most deadly cancers, if not detected and treated while the cancer is still confined to the bladder lining. If diagnosed in its early stages, bladder cancer has a 5-year survival rate of almost 95 percent. If diagnosed at an advanced stage, however, the 5-year survival rate is less than 10 percent. Fortunately, modern technology now allows for simple, inexpensive and noninvasive testing. It now costs far more to treat one victim of advanced-stage bladder cancer than to screen thousands of firefighters.

Cigarette smoking is the most common risk factor for bladder cancer (smokers are 4 to 7 times more likely to develop bladder cancer than nonsmokers), but firefighters are at risk even if they don’t smoke. Prolonged exposure to benzene compounds found in burning debris is associated with bladder cancer risk, so it’s not surprising that studies have shown that firefighters are twice as likely to have bladder cancer than the general population. Much of this exposure comes after the fire is knocked down, when firefighters are off air performing overhaul and still exposed to smoldering material.

Bladder cancer is about as common in men as colon cancer. It also has the highest recurrence rate of any cancer—even skin cancer. Bladder cancer is the second most common urologic malignancy in the United States (prostate cancer is the most common). Its prevalence is higher than lung cancer. Today, more than a half-million people have had or are living with bladder cancer.

Warning Signs
Firefighters can increase their long-term survival rates by catching bladder cancer early. To do this, you must be familiar with the warning signs. One of the first signs is blood in the urine (hematuria). Sometimes the urine appears normal and blood is detected only through a test. Hematuria is the most frequent symptom of bladder cancer. However, there are many reasons for hematuria, including urinary tract infections and nephrolithiasis (kidney stones).

Other signs of bladder cancer can include painful urination, increased frequency of urination, a feeling of needing to urinate but not being able to do so, and chronic bladder inflammation from recurrent urinary tract infections. While each of these symptoms might have benign causes, the possibility of bladder cancer should not be excluded, especially for those at higher risk.

Screening
We now have the means to test people at risk for bladder cancer using a point-of-care test that detects elevated levels of the NMP22 protein marker in a single urine sample. Most healthy individuals have very small amounts of the NMP22 protein marker in their urine, but bladder cancer patients commonly have elevated levels, even at early stages of the disease. The test is done in the doctor’s office and we have results during the patient’s visit. If the test is positive, the individual should be further evaluated for bladder cancer by a urologist.

This simple test can also be done in the workplace. Ask your chief or medical director how bladder cancer testing can be part of your health program.

Although we still have a way to go, progress is being made in raising firefighters’ awareness of the risk of bladder cancer. The bottom line: Early detection starts with you. Know the risk factors and signs of bladder cancer.

Barry Stein, MD, is currently the chief urologist for the Veteran Health Center, New Albany, N.Y. Previously, Dr. Stein was in private practice in the Providence, R.I. area. He’s actively involved with educating at-risk groups about cancer, including firefighters and veterans.