OCCUPATIONAL CANCERS: A CLINICAL PERSPECTIVE

WHAT IS SALTY?  After every fire call, members of the fire service would often come out with incendiary sediments like ash and soot lacing every part of their bodies and their gear. SALTY (as we know it today) are airborne particulates that are byproducts of all the burning materials in a fire- including toxins from hazardous materials activated at high temperatures.  This demonstration of cleaning a face mask after one use shows the filthy layer of soot that envelops all parts of a firefighter in action. The dark material also covers the skin, hair, eyes and breathing passageways that may eventually attribute to illness.

INTRODUCTION
By: Dr. Robert Bard

According to the researchers and government health agencies, smoke from fires and SOOT (or particulate matter) can contain many different types of toxic compounds including: 

- Aldehydes
- Acid gases
- Sulfur dioxide
- Nitrogen oxides
- Polycyclic aromatic hydrocarbons (PAHs)
- Benzene, toluene, styrene, metals and dioxins

Exposure to these compounds have a high probability of causing cancer. There continue to exist many HIDDEN DANGERS to inhaling or digesting fire smoke, and physical contact with toxic particulates. Fire departments these days are implementing a wide range of safety protocols including required cleaning of their gear and all surfaces that they come into contact with because extended exposures to these chemicals throughout a firefighter’s career can lead to cancer down the road.

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JOB-RELATED CANCERS By: Dr. Ben Ho Park (Originally published Jul 12, 2021) 

The more we follow and the more we learn, the more we recognize that there are both short and long term exposures and risks that lead to diseases like cancer- some of which won't manifest for many years.  An example of this is the airline industry where smoke used to always be present and second-hand smoke led to the realization that that was a carcinogen for airline attendants. Similarly speaking for firefighters, the initial exposure to smoke and all the other potential carcinogens can lead to damage in the lungs and the whole upper aero-digestive track as we call it. But in the long run things like cancer and perhaps even other lung diseases may arise as part of accumulative effects of those exposures that may seen again decades later.

As things burn, chemical modifications happen. Things that don't normally exist together now are made to synthesize using fire or heat.  When this happens, there's further opportunities that any one of these new combinations that are synthesized from the heat and all these other chemicals mixing together could in fact be even more potent carcinogens. The fact that this can often take years before it manifests as diseases like cancer is actually very consistent with what we know on how cancers form.  Cancers don't happen overnight and the DNA damage that leads to cancer actually has to happen very slowly over years because cancer isn't just one DNA mistake in a cell-- it's actually multiple DNA mistakes in the same cell. It takes several years- often leading to a decade or more before it manifests into something that we clinically can detect as a tumor.

ON RECURRENCE
Through surgery or non-invasive procedures, we have the ability to remove all the cancer. On the other hand, cases have proven that microscopic cells may be left behind and those are ultimately the cells that could grow back and become metastatic recurrence. Oncologists make decisions based upon past clinical data about which patients would carry those microscopic cells after surgery or radiation. Meanwhile, options are available called systemic therapies, which includes hormone therapies and chemotherapies, but should recurrence occur, they may return in a variety of forms or locations in the body with varying levels of aggressiveness.  One could probably assess that if you have an aggressive form of prostate cancer, then the chances or likelihood of having microscopic cells left behind is greater. And that those are ultimately the cancers that will recur faster.

"PREDICTING" CANCER
It's not unusual that you could actually see toxins  get absorbed systemically through the lungs and may wind up becoming a carcinogen to another organ - regardless of its first contact. Once it hits the bloodstream, anything is fair game in terms of susceptibility.  Various possibilities for this include  micro-environmental factors; as an example, when one thinks about the breast cancer susceptibility genes [BRCA 2], those who have inherited the mutation would have that mutation in every single cell in their body. But predominantly the cancers that occur, at least in women are going to be breast and ovarian cancers. It's because of the interplay between the local environment or micro-environment, and the actual carcinogenic insult to the DNA.

Diagnostic technologies continue to improve, and arming our first responders with these portable field scanners is innovation that are now being pursued.  In addition, implementing more regular screening and early detection scans for firefighters is ideal because of increased risk and exposure.  Historical comparison shows progress is certainly evident when it comes to frequent testing for active and retired firefighters. The best way protect firefighters with prevention is to catch it earliest – where there is the highest probability of a cure.  

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