Three in San Diego Have Died of Cancer : Fighting Fires--a New Element of Risk

Nick Sheridan never thought much about “the health thing” during his first eight years fighting fires. Then three fellow San Diego firefighters died of cancer a few years back. Sheridan started thinking.

One case, abdominal cancer, occurred in Sheridan’s own station. He says the two others, lung and stomach cancer, were in his district. Sheridan raised the issue at the labor council. Then his union turned to the medical community for help.

Now the San Diego Fire Department is the subject of a long-term study on the health effects of fighting fires, led by two University of California, San Diego, medical researchers. Specialists say the investigation is likely to be the most comprehensive on what is an increasingly complex and troubling question.

The study comes at a time when plastics, synthetics and toxics have created extraordinary new risks in the most ordinary fires. Yet the health effects of exposure to toxic fumes at fires have been inadequately studied, and the findings remain inconclusive.

Left Wondering

As a result, firefighters have been left wondering about what many believe to be elevated rates of heart and lung disease and cancer in their profession. In addition, the lack of definitive findings has slowed efforts to improve protection.

“We have some indications of pulmonary problems, cardiac disease and increased risk for cancer, but we really don’t have that much information defining health problems for firefighters,” James M. Melius of the National Institute for Occupational Safety and Health said. “Particularly in the context of the types of exposures they may be experiencing now. The environment may be very different from what they experienced in the past.”

More than 500 of 725 San Diego firefighters have received complete physicals and tests of heart, lung, liver and kidney function. They have answered questions about coughing, wheezing, phlegm and stress; dug through records on job assignments and hospitalizations, and tried to recall past exposures to toxics. The researchers, led by two occupational health specialists from UC San Diego Medical Center, hope to expand the study. They want to track down 850 firefighters given lung tests in San Diego between 1960 and 1972 and re-screen them.

They have not begun to analyze the data, which would overwhelm even the medical center’s computer. They decline to talk about their informal observations, except to say they have already found considerable loss of hearing--a phenomenon that has received little study. But over the next year the researchers hope to come up with a diagnosis of the department’s physical health in the early 1980s. That “base-line data” will serve as a standard of measurement for tracking changes over decades to come.

Unusual in Other Ways

The investigation is unusual in other ways, too.

It was initiated by Local 145 of the International Assn. of Firefighters, and it is being done for a small fraction of its cost because doctors, nurses and other medical professionals have volunteered their time. It is also taking place in a city where houses and industries are relatively new and often built with synthetic materials--in contrast to firefighter studies done in older cities like Boston and London.

Researchers have long been curious about firefighters’ health--in particular, the effects of stress on the heart, and smoke on the lungs. But concern has widened recently to the “products of combustion” of the plastics, pesticides and other chemicals burned in everyday fires.

Among those are carbon monoxide, a toxic gas that quickly displaces oxygen in the blood. Hydrogen cyanide, from burning synthetics and urethane foam, inhibits the body’s ability to use oxygen. Benzene, a known carcinogen, appears to come from burning plastics. Other hazards include hydrogen chloride, a respiratory irritant emitted by the polyvinyl chloride (PVC) used widely in wire insulation and plumbing. Cyanide is released from burning plastic polymers. Asbestos disperses into the air around burning buildings.

“Look at this room: We have a door made of plastic, a desk made of plastic, a rug made out of synthetic material,” Dr. Gary R. Fujimoto, the study’s author, said, eyeing his office in Hillcrest near downtown San Diego. “Every year, more and more of these materials exist. So the whole nature of firefighting is undergoing a dramatic change because of the changes in the composition of people’s homes.”

Partially Outdated

Firefighters’ protective equipment has only partially kept pace.

For example, their “turnout gear” has improved over time--ironically, along with the development of the kinds of synthetics that have created new problems. The so-called self-contained breathing apparatus has improved, though it remains cumbersome.

But some firefighters admit it can be a matter of pride not to clean one’s turnout gear, though it can become badly contaminated during a fire. For convenience, they often remove their tanks during the slow-burning, later phase of a fire when the toxic danger may be most severe. Furthermore, firefighters have rarely kept records of what they were exposed to during fires. Often, there is no way of knowing what burned--much less what it turned into when it caught fire.

“It’s the long-term effects that I think we don’t fully understand and may not be looking at adequately,” Fujimoto said. “We don’t have the tools right now to be able to have that instant type of analysis.”

An assistant clinical professor of medicine, Fujimoto, 32, was one of the doctors that Sheridan turned to in 1982. An occupational health specialist who had worked with a doctor who studied Boston firefighters, Fujimoto has put hundreds of hours into the study.

11-Page Questionnaire

The study begins with an 11-page questionnaire that each firefighter fills out, identifying himself with a number for confidentiality. It covers past and present conditions including medical, work and family histories. It also asks what types of fires the firefighter has fought, such as industrial, motor vehicle or residential fires. It then inquires about instances of smoke inhalation, use of air tanks and hospitalization.

Next, each firefighter undergoes physical testing at a community clinic in Pacific Beach. There are blood tests, hearing tests, an electrocardiogram and lung tests measuring ability to empty one’s lungs.

The results are returned to each firefighter, along with comments from Fujimoto. Because it is a screening program, the project offers no long-term treatment. But Fujimoto said some firefighters call back for additional information.

The union pays $60 a firefighter toward the costs of lab tests and administering the program. Fujimoto estimates that the cost would range from $200 a firefighter at an economical clinic to $1,000 if the work were done at the medical center.

Some firefighters have declined to participate. Fujimoto and others said the results may be jeopardized if many are missing, depending on whether they are relatively young or older veterans of the force.

Meanwhile, Fujimoto is applying for a grant to track down the firefighters and former firefighters screened in the earlier study.