El combate de incendios y el cáncer: información general sobre la evaluación de la IARC y su impacto

Hello and welcome to our Chronic Disease Council Nora National Occupational Research Agenda webinar titled Firefighting Exposures and Cancer An Overview of the International Agency for Cancer Research Assessment and Its Impact Mi My name is Tod Stickle and I am the coordinator and co-chair of the Nora Chronic Disease Council. The Chronic Disease Council, or CRC, is part of the national occupational research agenda. The primary mission of the Council is to provide national and international leadership for cancer prevention. work-related adverse reproductive outcomes cardiovascular and other chronic diseases In diverse populations naos is the administrator of Nora we collaborate with industry workers commerce professional organizations and academia to facilitate important research identify understand and communicate effective strategies of intervention and prevention and learn how to implement strategies to reduce occupational chronic diseases our disclaimer States that the findings and conclusions in these presentations are those of the authors and do not necessarily reflect the official position of the National Institute for Occupational Safety and Health nor At the Centers for Disease Control and Prevention, we are pleased to announce that an archived copy of the full webinar in English and Spanish will be available on the CDC YouTube channel in late 2023. You can share the link with friends and colleagues to watch this full webinar today we have a very interesting list of speakers many of them were key figures in the arc monographs working group First we will have Dr Paul who was the chair of this arc working group and is the director of the occupational cancer research center in Ontario Canada next we will have Dr Kenny Fent children's industrial hygienist and leader of the National Fire Registry here in the United States then we will have Laura Bean Freeman epidemiologist from the National Cancer Institute After her we will have Dr. David Demarini, emeritus scientist of the United States Environmental Protection Agency, then David, we will have Dr. Natasha Sher Sol, associate research professor at the University of Miami in Florida, and finally, we will have Dr. Mary Schauer Bergen, director of the monograph program at la in lon France and with that said I have the pleasure of introducing you to Dr. Paul de My name is Paul de and I am the director of the occupational cancer research center in Toronto Canada I am also a professor at the university of Toronto I was also president of the working group from the international agency for research on cancer or arc that evaluated the occupational exposure of firefighters and I will give you some background on the aarc and the evaluation For those who do not know it, the international agency for research on cancer is part of the World Organization Health and its monograph program is the international leader for the evaluation of suspected causes of cancer. The suspected causes are classified into four categories that are seen here: carcinogenic group one, probable group 2a, possible group 2b, and non-classifiable group 3 for who do not fall into any of these three groups the arc evaluates firefighting for the first time in 2007 24 scientists from 10 countries concluded that firefighters are exposed to many known and suspected carcinogens and based on an analysis of cancer studies available at the time identified testicular cancer, prostate cancer and non-HK inian lymphoma as having the strongest evidence however epidemiological studies were uneven and there were other limitations so the final assessment was that firefighting may possibly be carcinogenic to humans 12 years later in 2019 an advisory group met at the arc to recommend priorities for the next 5 years for firefighters the advisory group noted that there were many new studies the new studies had fewer limitations and the larger and longer studies had more consistent results the new mechanistic studies available found evidence of more DNA damage oxidative stress and other pathways therefore the recommendation was to re-evaluate firefighters in 2 and a half years in 2022 the arc again To evaluate the exposure of firefighters 25 scientists from eight countries met in three subgroups exposure cancer in humans and mechanistic evidence in a moment they will hear from a member of each of those subgroups who will talk about the evidence they analyzed and their conclusions but the overall assessment was that occupational exposure of firefighters is ca ogical in group one humans recently the full monograph was published and a summary was also published and both are available on the aarc website Thank you Hello My name is Kenny Fent I'm a research industrial hygienist at the National Institute for Occupational Safety and Health Today I'm going to talk quickly about the firefighter exhibits Before we talk about the exhibits I think it's important to recognize the different types of firefighters the two main types of firefighters They are those who fight structural or municipal fires and those who fight forest fires. The latter are trained to fight large vegetation fires or forest fires and this includes digging trenches and removing brush to stop the progress of those fires. Firefighters who fight structural fires are trained to fight structure or vehicle fires But they may also respond to vegetation fires and other emergency events Firefighters may be career employees temporary employees which is common for firefighters fighting wildland fires or volunteers it is not unusual for a Firefighter is a career firefighter in one department and a volunteer in another or who begins his service as a volunteer and then becomes a career firefighter. In addition, firefighters can specialize further, some subspecialties include industrial firefighting and airport rescues, training and investigation of the causes of fires. fires each of these subspecialties requires a specific set of skills and could have unique exposures in terms of exposure firefighters could be exposed to nighttime work V radiation especially among firefighters who fight forest fires exhaust gases from diesel engines products of combustion and other material released during fires the international agency for cancer research or aarc classifies agents into three groups shown here at the end night work is classified as a probable group 2 carcinogen to radiation V is classified as a known group one carcinogen in humans diesel engine exhaust is also classified as a known group one carcinogen in humans there are multiple combustion products that are group one carcinogens such as benzene bene pyrene formaldeide and vinyl chloride it is important to note that vinyl chloride comes from plastics man-made materials such as plastics foams and other polymers produce additional dangerous substances when burned some of them are carcinogenic such as certain dioxins and furans there are also other materials that an During fires that are group one carcinogens for example asbestos silica And cadmium finally firefighters may use materials that contain hazardous substances such as aqueous film-forming foams or aipf that have historically contained perfluoroalkylated and polyfluoroalkylated substances or pfas the way in which firefighters could be exposed to chemicals is complex this diagram shows the possible routes of exposure for firefighters fighting structural fires firefighters commonly use self-contained breathing apparatus or scba during firefighting a structural fire inside but may not wear them outside the structure or may remove them Once the fire has been extinguished in which case unprotected inhalation exposure is possible even when wearing self-contained breathing apparatus some chemicals may penetrate Barriers protective parts of their protective equipment and come into contact with the skin in which case dermal absorption is possible after completing their firefighting activities firefighters remove their protective equipment some contaminants found on the protective equipment release gases and create additional opportunities for inhalation exposure. Some contaminants could pass onto the skin when firefighters are handling their equipment, thus creating the potential for more skin exposure and absorption. Firefighters' hands in particular are likely to become contaminated in which In this case, exposure through ingestion is possible. Depending on hand hygiene, contaminated equipment that is not adequately decontaminated could act as a reservoir for continued exposure when used again. Diesel engine exhaust is also present in In fire cases and other emergency responses, it is important to note that firefighters fighting forest fires do not use the same type of protective equipment. Their protective clothing is lighter and firefighters often do not wear any respiratory protection. They may also be sent to to fight a forest fire for several weeks in a row with limited access to showers or protective clothing Clean change of clothes Firefighters who fight forest fires also commonly use fuel or gas-powered equipment such as chainsaws and drip torches so they could be exposed by inhalation thermal absorption and ingestion pathways what it looks like firefighters of all types could be exposed to carcinogens during fire responses and other work activities and these exposures are not just chemical in nature equipment contamination is a major concern in terms of take-home occupational exposures and cross-contamination Firefighters in specific disciplines may also have unique exposures such as the use of aqueous film-forming foams and man-made materials when burned create additional hazards such as vinyl chloride or dioxins Understanding the pathways of exposure helps identify possible control interventions to reduce it and fortunately many departments have implemented new policies and procedures in order to reduce these exposures thank you Hello My name is Laura Bin Freeman, I am a senior researcher at the National Cancer Institute. the United States and was a member of the epidemiology subgroup on the recent AARC monograph on the assessment of occupational exposures of firefighters in the 2022 ARC review, there were many studies that were had been carried out since the previous review In 2007 the working group io 52 cohort and case control studies 12 case reports and seven meta-analyses that were potentially applicable due to the extensive epidemiological evidence the irc working group conducted its own meta-analysis of the most informative studies to evaluate 12 types of cancer A meta-analysis is a method by which the results of individual studies are combined to obtain an overall estimate of effect, which can be very useful as it allows researchers to consider the results. of studies conducted in different settings in total the working group determined that there were more than 30 cross-sectional studies from around the world that were the most informative in essence of the highest quality in their evaluation of the epidemiological evidence. In addition to the meta-analysis the group of work reviewed the quality of individual studies including their strengths and limitations Possible sources of bias such as those that could be caused by increased medical surveillance and possible confounding such as different rates of important lifestyle factors such as smoking between the groups of comparison that could explain the differences observed after a complete review the working group determined that there was sufficient evidence that the occupational exposure of firefighters was causally associated with two types of cancer mesothelioma and bladder cancer in the case of mesothelioma there was Seven studies investigating incidence rates in firefighters included in the analysis revealed an increased risk of 58 percent compared to the general population, firefighters could encounter asbestos on the job, which is a historically plausible causal agent. Asbestos was used in building materials and has been shown to cause mesothelioma in other settings although this has not been specifically reviewed in this monograph. In the case of bladder cancer there were 10 studies included in the meta-analysis that evaluated the incidence of cancer resulting in to an increase in risk of 16 percent in firefighters, although this increase is slight, there was uniformity between the studies in the meta-analysis and also uniformity with two other high-quality cohort studies with a broader definition of bladder cancer and with studies on mortality that had also not been included in the meta-analysis, it was determined that this increase was probably not due to other factors or bias in the epidemiological studies. In addition, firefighters have exposures to known or suspected bladder carcinogens such as somatic polyar hydrocarbons and eloin there were five additional types for which the aarc task force determined there was limited evidence of a causal association These types include testicular prostate colon cancer melanoma and non-hoch kinan lymphoma this means that while there was some credible evidence of a greater risk among firefighting And these types of cancer bias could not be ruled out probability or confounding in particular surveillance bias or medical examinations were a concern Regarding prostate and colon cancers there was also evidence that the style of life and physical characteristics Could have confounded the relationship between these cancers and firefighting for all other cancers evaluated epidemiological evidence was determined to be insufficient the task force in particular noted a reduced risk of cancer overall this was probably due to lower smoking rates in firefighter populations and bias in epidemiological studies and while there was some evidence of an increased risk of thyroid cancer this was mainly attributed to increased medical surveillance in the firefighters compared to the general population in summary there were two types of cancer for which the task force determined that there was sufficient evidence of a causal relationship between the occupational exposure of firefighters there were five additional types for which there was some credible evidence of a higher risk but for which probability bias or confounding could not be ruled out these include testicular prostate colon cancer melanoma and non-hoch kinan lymphoma Hi, I'm David de Marini and I'm going to describe the mechanistic evidence regarding the carcinogenicity of the occupational exposure as a firefighter as described in the monograph of the international agency for research on cancer or ar volume 132 to begin general information mechanistic evidence Explains how an agent causes cancer the ar takes into account 10 mechanisms by which an agent can cause cancer the working group for this monograph significant evidence for five of these mechanisms by which occupational exposure as a firefighter causes cancer so let's look at those five mechanisms the first is genotoxic fighting fires causes DNA damage in blood cells and the mouth and introduces chemical substances into the blood that cause mutations in the DNA therefore fighting fires is genotoxic secondly lug causes epigenetic alterations fighting fires activates or deactivates genes associated with cancer in an inappropriate way Therefore fighting fires causes epigenetic alterations Third causes oxidative stress fighting fires produces toxic forms of oxygen in the blood that damage DNA and other molecules therefore fighting fires causes oxidative stress fourth causes chronic inflammation fighting fires results in higher levels of inflammatory proteins that damage the tissues and remain for a long time after fighting a fire therefore fighting fires causes chronic inflammation and fifth and lastly it modulates the effects mediated by receptors fighting fires introduces chemicals into the blood that bind to proteins that can activate cancer genes therefore, firefighting modulates receptor-mediated effects. There are two key conclusions as a result of this analysis. The first is that mesothelioma, which is cancer of the cells that line the lungs and other internal organs as identified by the epidemiology subgroup, is likely to occur. due to asbestos exposure from structural fires and the second is that the bladder cancer identified by the epidemiology subgroup is probably due to cyclic aromatic hydrocarbons or hap are the main type of carcinogens in combustion emissions or the smoke Hello My name is Natasha Shefer Soli and I am a nurse scientist and associate professor at the University of Miami Silvester Comprehensive Cancer Center as you have heard previously from my colleagues the reevaluation of the irc monograph analyzed important research related to exposure epidemiology and the mechanisms of cancer in firefighters to determine a new classification of firefighters I will now share with you some key recommendations for the prevention of cancer in firefighters at both the individual and organizational levels as well as report on research interventions that focused on the cancer prevention in the fire service for cancer prevention at the individual level there are several modifiable risk factors that firefighters can implement into their lifestyle such as having an annual physical exam that includes a complete medical history and physical exam as well such as laboratory tests and evaluation of all body systems including a Mental Health evaluation completing cancer screening tests that are recommended based on the American Cancer Society and the United States Preventive Services Task Force and NFPA Standard 1582 Cancer screening should be tailored to firefighters based on their risk Also maintain a healthy diet and weight by limiting sugary and processed foods Be active physical regularly avoid risky behaviors Even the use of tobacco or drugs limit alcohol consumption and use sunscreen regularly lastly we have good sleep hygiene we know that an inadequate amount of sleep has been shown to increase the level of stress hormones as well as inflammation at the organizational level there are several things that firefighters and fire departments can do to reduce exposure risks for firefighters some things include completing decontamination practices this includes decontaminating on site after a fire or hazardous materials incident establish rehabilitation in a cold area and clean exposed parts such as hands, face and neck before eating or drinking also reduce carcinogenic transmission by showering within the hour do not have personal protective equipment or PPE in the where they live and transport equipment in airtight containers when in personal vehicles also promote the washing of protective equipment on a regular basis including having a change of personal uniforms and using the station's washing machines for all appropriate clothing Developing and implementing a written policy for cancer risk reduction activities within your department could help increase cancer prevention strategies. finally create a health and safety committee with a specialized health and safety officer in order to promote cancer prevention activities within the department. Some examples of cancer interventions in the fire service have included a study that analyzed a workplace sleep health program that incorporated sleep health education and sleep disorder screening to improve the health and safety of firefighters in addition to decontamination processes we saw that on-site decontamination using water and Dish detergent and scrubbing could reduce somatic polyar hydrocarbon contamination in protective equipment by an average of 85 percent. Another study that analyzed multiple gas detectors in a hot zone showed that firefighters should implement strategies for the use of multiple gas detectors as well as respiratory protection in hot zone areas. Lastly, there is the analysis of cultural change. This study presented an intervention theory-based communications tailored to the specific context of high reliability organizations norms and self-efficacy were the most significant predictors of current behavior specifically when analyzing decontamination practices to reduce exposure some key messages that emerge from this section are about Cancer Risk Awareness Firefighters should be aware of their occupational risk factors for cancer and understand ways to mitigate their risk at both the individual and organizational levels. Second are their annual physical checkups and screenings. One of the keys to cancer prevention is early detection and cancer screening based on your occupational cancer risk. And finally there are cancer interventions. Cancer health interventions are essential to understanding the needs of people. firefighters and provide opportunities for change My name is Mary Schauer Berigan and I am the head of the monographs program of the international agency for cancer research or aarc here is a brief summary of the impact of the arc monographs on evaluation of the carcinogenicity of occupational exposure of firefighters la arar has been evaluating the impact of our cancer hazard classifications including firefighting as a carcinogenic occupation today I am going to mention three initiatives first is the impact on the scientific community second is the broader impact of the evaluation throughout the internet third I will give you some specific examples of the impact around the world first we analyzed the scientific references of the meeting summary published in the journal of lanet oncology we searched Google scholar for all the scientific articles that cited this summary that was published in June 2022 we found 57 articles published between that time and mid-July 2023 next we searched the internet for mentions of the irc with firefighters and cancer to analyze the longer-term impact we searched only in the first half of the 2023 without counting the scientific references found in the first search we found 57 unique websites that mentioned the evaluation What we found more than a third of the scientific articles focused on the evaluation of exposures especially for polycyclic aromatic hydrocarbons or PAHs there were also many articles related to exposure reduction and cancer epidemiology there were few studies describing cancer screening testing or cancer compensation And none related to legislation web pages on the internet referring to the evaluation of the arc were much more focused on controlling or reducing exposures contamination of protective equipment and especially on issues related to compensation more than one in five websites cited legislation that had been adopted to help firefighters exposures to rented poliflor or PF As were the most worrying, the arc created an infographic to accompany the summary of the meeting. It has been shared hundreds of times online and on social media. It has even been printed as a large poster and displayed in fire stations. Many of the references in Internet were from fire brigade unions such as the UK Fire Brigade Union cited the IRC assessment for strengthening the case for better decontamination methods better health assessments and exposure recording in this example from sask chuan Canada Emphasis is placed on better training and prevention methods to reduce carcinogen exposures among firefighters. I hope that in these few examples you have gotten an idea of ​​the impact of the irra assessment of the carcinogenic hazards of firefighting. We thank you our entire working team for their exceptional contributions We hope you enjoyed today's webinar the guest speakers would like to thank the entire aar monograph volume 132 working group special thanks to Mary scher Bergen Nat debeno and solin kahan Finally thank you to the entire RA secretariat team for your efforts on this assessment the speakers would like to share some key scientific references If you would like more information on specific topics related to firefighting and cancer exposures included full quotes from the evaluation and full monograph below We would like to take this opportunity to encourage all firefighters to join the National Firefighter Registry to reduce cancer in firefighting teams share link you see in the screen with your fellow friends and family firefighters Thank you for joining us today If you would like more information about the Nora Chronic Disease Program, do not hesitate to visit our website or send us an email to these addresses enjoy the rest of the day