By: Russell F. Osgood, Firefighter Cancer Support Network, Vice President of Education
I would imagine as a firefighter you know someone who has been diagnosed with cancer only to discover that it is in late stages. I know I have seen my fair share over the years. Seeing this each time reminds me of how important it is to set benchmarks for your own health and to pay close attention to the many methods we have to detect problems before they reach the point where the options can be disastrous.
Occasionally, I hear the debate about what the number one killer of firefighter is: heart disease or cancer. Does it really matter? I would suggest that it doesn’t, because they are both are deadly to firefighters and many of the prevention methods are the same.
Prevention tools for early detection
I’d like to focus on one of the tools that you can use to help detect problems early on: health screenings. The benefits of early detection are staggering. For example, discovering skin cancer at stage one has a 99% survival rate, however, if found at stage 4 that survival rate drops to 25%. The same can be said for early detection of heart disease, a simple scan can find atherosclerosis decades before you might have a heart attack or stroke. This gives you a chance to treat the causes and make lifestyle changes that reduce your risk and, in some cases, completely reverse the damage.
Screenings detect early health changes before symptoms appear. In my case, a screening revealed something I did not consider a risk. From time to time I hear firefighters say that they’re not sure if they want to participate in a screening because they just don’t want to know, or they’re too busy, sometimes it’s “oh that’s too invasive”, which seems a bit foolish to me when early detection is a key to survival for so many medical conditions including the top killers of firefighters, heart disease and cancer.
My own experience with screenings started when I attended a firefighter health seminar at Boston Fire and received a skin cancer screening that led to me going to a dermatologist and having what my dermatologist calls a garden of precancerous spots removed from my head annually. I know that if I hadn’t attended that seminar, I wouldn’t have seen a dermatologist and those precancerous spots would likely have become cancer, which could have led to a very different outcome. A few years after that an opportunity to participate in a lung cancer screening as a part of a firefighter health study presented itself. Understanding the benefits of screenings, I signed on. What I was most concerned about was lung cancer. What I discovered was not even on my radar. I received my results and discovered a heart disease risk that should be reserved for someone 25 years older.
Which health screening is needed?
What are the screenings that firefighters need to get and when? This is a question that for over a decade Dr. Michael Hamrock, a former Boston Firefighter and Boston Fire Medical Officer has been addressing. His recommendations come in the form of a letter to physicians explaining a list of screenings that look at both heart disease and cancer in firefighters. His program is a great place to start. Dr. Hamrock has seen the unique risks firefighters face and makes recommendations for several screenings that go along with a comprehensive annual physical. Age adjustments are made to the normal recommendations based our unique risk, saving lives by finding problems before they are too late to overcome.
An overall physical assessment is a great place to get started, something that you should be doing annually. This recommendation is simple, takes only a few hours out of a day and sets a baseline for your health. This is where you and your doctor have a chance to get to know each other and learn what makes you someone that they need to pay closer attention to because of the unique exposures that you face from the job. Remember, you need to educate your physician on your risks so they can move forward with other screenings. Take a copy of Dr. Hamrocks letter or the International Association of Fire Chiefs Healthcare Providers Guide to Firefighter Physicals to get the conversation started.
There are several recognized screenings and it is important to understand how they work, when to do them and what the results mean. Let’s look at six recommended cancer screenings breast, cervical, colorectal, lung, prostate, and skin. Some screening tests are used only for people who have known risk factors or a higher risk of cancer which may include, personal history of cancer, family history of cancer, certain gene mutations, exposure to cancer-causing agents, or age. This is problematic for firefighters as we know that in many cases, we have a risk from occupational exposure that the general population does not. This makes it critical that we have screenings earlier and that we educate our physicians on our risk and the need for screenings at earlier ages. Remember that self-exams are so important. Learning how to check the testes, breasts and keeping a close eye on your skin will help you stay on top of issues and in some cases trigger additional screenings.
A mammogram is the recommended screening for breast cancer. Firefighters at age 35 should start annual breast cancer screening with mammograms, which consists of an x-ray of the breasts. Women should also know how their breasts normally look and feel and report any breast changes to a health care provider right away.
Colon and Rectal Cancer
The American Cancer Society recommends starting regular screening at age 45 for average risk of colorectal cancer, however the firefighter has an increased risk for colon cancer which makes it necessary to start colon screenings at age 40. There are two types of screenings. First, a sensitive stool sample test that looks for signs of cancer. The result of stool sample testing should be interpreted with caution. A positive test result does not confirm the presence of cancer. A positive test result should be referred for diagnostic colonoscopy and a negative test result does not confirm the absence of cancer. The second is colonoscopy, the recommended screening beginning at age 40 for firefighters. The screening is an examination of the inside of the colon using a colonoscope, inserted into the rectum. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing and a tool to remove tissue that may need to be examined for cancer. I have heard firefighters that just don’t want this test due to its intrusive nature. I think it is important to understand that although it might seem that it could be uncomfortable the screening is quite simple, and they even offer you medication that makes you not care one bit about the process.
The American Cancer Society (ACS) recommends that men make an informed decision with a health care provider about whether to be tested for prostate cancer. In the fire service circles it is recommended that firefighters start the discussion about annual prostate screenings at age 40. According to the ACS research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. This is something that you need to understand and discuss with your doctor. If you decide to be tested, you should get a PSA blood test with a rectal exam. How often you are tested will depend on your PSA level and the decisions you and your healthcare provider make.
Female firefighters should discuss the risk with their physician. According to the ACS cervical cancer screening should start at age 25. There are two parts to the test. First, is a pap test or pap smear. The procedure uses a small brush to collect cells from the surface of the cervix and the area around it. These cells are viewed under a microscope to find out if they are abnormal. An HPV test is used to check DNA or RNA of HPV infection. Cells are collected from the cervix are checked to find out if there is an infection caused by a type of human papillomavirus that is linked to cervical cancer. This test may be done using the sample of cells removed during a pap test and is also conducted if abnormal cervical cells are found during the pap test.
Mesothelioma is one of the top cancers in firefighters making lung cancer screenings crucial. The benefit to early detection of lung cancer results in 20% less deaths than compared to a simple x-ray. Another benefit of low-dose CT scan used in lung cancer screening is the CT scans don’t just examine the lungs it scans the entire chest cavity. The most recent screening guidelines provide that people at increased risk for lung cancer, receive yearly lung cancer screening with Low Dose CT scans. The basic recommendation is for 50 to 80 years old in fairly good health who currently smoke or have quit in the past 15 years and have at least a 20 pack-year smoking history. (This is the number of packs of cigarettes per day multiplied by the number of years smoked). Firefighters should discuss the benefits of a LDCT scan with their physician. Dr. Hamrock recommends firefighters receive this important scan starting at age 50. For me this was the 15-minute scan that discovered cardiac disease and has given me the chance to reduce my risk through treatment and lifestyle changes.
Skin cancer is the most common cancer in the United States. Melanoma, which begins in the pigment-producing cells of the skin, is one of the cancers firefighters get often. Dermatologists recommend that you stay on the lookout for moles that have asymmetrical shape, an irregular border, especially one that seems scalloped or wavy, changes in color, including more than one color in the mole, and if it grows rapidly or exceeds around 1/4 inch.
While an irregular mole offers the most obvious, and frequently the most familiar, sign of melanoma, melanoma can occur anywhere on the skin. Making it critical to rely on a skin screening from a dermatologist. Any time you notice changes in color or irregular growths on your skin, you should consult a doctor as soon as possible to rule out melanoma and other related skin cancers. In fifteen minutes, you could make the difference between life and death as melanoma is highly curable when found in the early stages.
Firefighter skin screenings can be done by a local dermatologist by simply contacting them and asking if they would sponsor an American Academy of Dermatology SPOT Skin Cancer™ Screening for your department. The State of Massachusetts has had great success using this method under the direction of Dr. Christine Kannler.
Costs of health screenings
There is a cost to screenings that is often absorbed through insurance, however if insurance fails to cover the expense it would be prudent for the firefighter too view this as maintenance. Just like you change your oil in your vehicle or put on new tires after seeing they are a bit short on tread, we also need to pay attention to what’s going on in our bodies. A colonoscopy for example may cost $300 to $500 out of pocket which is far less money than the cancer treatment or loss from work you may face with a late discovery of cancer. Remember that as firefighters we face many dangers and need to use all the tools available to us so we can live healthy long lives. Take the time to talk with your physician and schedule a screening today you never know you may find something that is easily corrected today or a condition where simple lifestyle changes can manage or correct the ailment.
It is up to you to advocate for your health, pass on the facts to your physician, so together you can decide what is best for you as a firefighter.