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May 08, 2023

New registry could shed light on link between wildland firefighting and cancer

In 2019, Kat Navarro worked a season with the Redmond Hotshots, a Forest Service

In 2019, Kat Navarro worked a season with the Redmond Hotshots, a Forest Service crew based on the east side of the Oregon Cascades.

Late that summer, they were on a fire in the Malheur National Forest. In videos she recently shared with me, thick smoke filled the dense woods.

Navarro was doing the same tough work as everybody else, and that long summer served as an intense crash course on the complex reality of wildland working conditions.

"One of the big takeaways that I had was that this work environment is incredibly complex and it's full of risks," she told me. "There are things that are going to, you know, harm you, hurt you, injure you immediately, and oftentimes that's what we're concerned about. And so it's really hard to think about, ‘how do we mitigate exposures for things that may not harm us immediately?’"

Navarro has an environmental health Ph.D. from the University of California, Berkeley, and she's especially interested in the long-term impacts of heavy exposure to smoke and other things that wildland fires regularly come into contact with, including volatile organic compounds like benzene. She now coordinates the Interior Department's new Wildland Firefighter Health and Wellbeing program.

"As far as what we know about the long-term health effects, there's really only two studies out there that have looked at that," she said.

One from 2016 found a link to a higher risk of heart arrhythmia and hypertension, as well as a greater likelihood of needing knee surgery among wildland firefighters.

"Which makes sense when you're carrying a very heavy pack down steep hills," Navarro said of the surgery finding.

She was the lead author on a 2019 study that found "an increased risk of lung cancer that ranged from 8% for a five-year career to 43% for a 25-year career," Navarro said. "And then for cardiovascular disease, an excess risk of 16 to 30%."

A big part of why there's little else on the subject is due to how hard the research is to conduct: The study subjects are an itinerant, seasonal workforce doing back-to-back 16-hour days in often hostile, remote locations that aren't kind to lab equipment.

Despite that, Navarro sees burgeoning interest all around her.

"There's a lot of support both internally and externally," she said. "And it's really exciting."

One new effort is the National Firefighter Registry, which Navarro expects to become a "great tool." The NFR's online portal went live in April, and I called Kenny Fent with the CDC's National Institute for Occupational Safety and Health to learn more about it.

A 2018 bill mandated its creation, explained Fent, a research industrial hygienist and NFR team lead. The registry seeks to improve understanding of the association between all types of firefighting and cancer and help reduce those risks.

"If you're diagnosed with cancer, it's getting reported to the state in which you live," Fent said. "But what's not happening, the knowledge gap we're trying to fill is actually collecting that occupational information about firefighters and then linking with the cancer outcomes and then trying to understand what it is about firefighting that is leading to an increased cancer risk."

Researchers have found higher rates of several cancers across the firefighting profession, and a group of World Health Organization researchers even classified the work as carcinogenic last year. While Fent praised the scholarship that's out there, he was frank about some shortcomings.

"Most of the studies that have been done have included primarily white male firefighters from large municipal departments who were employed decades ago," he said.

That limits insights into the risks firefighting poses to women, people of color, volunteer firefighters, and wildland firefighters – "knowledge gaps" that were key motivators for creating the NFR, Fent said.

"We probably know the least about wildland firefighters and their long-term health outcomes," he added. "Because of that, it's especially important that we get wildland firefighters to enroll in the NFR."

To do the sort of rigorous analysis Fent hopes for, the registry has a goal of enrolling 200,000 people over the next several years – and some 10 to 15,000 with wildland experience. As of late May, some 5,000 had registered, 16% of whom had worked on wildfires.

One of them is Pete "Dutch" Dutchick, chair of the advocacy group Grassroots Wildland Firefighters’ health and wellbeing subcommittee.

Dutchick does training and workforce development now, but has spent most of his 20-year wildfire career out in the woods, either with handcrews – large squads of up to 20 people tasked with digging and sawing miles of fireline – or smokejumping.

"What that looks like is you're waking up early, usually between 5 and 6:00," he said of a typical line shift. "You're sleeping outside, so you're sleeping in the smoke, in the elements… You're grabbing a quick bite, maybe a cup of coffee, and then you're headed out to the line for the day. And again, you're just consistently, often surrounded by the smoke, the dust."

He had firefighters under him whose safety he was responsible for, and then the birth of his daughter brought his health concerns into further relief.

"Really what was the turning point for me was losing close friends and former coworkers to cancer that were either right around my age or maybe just a little older," he said.

He called the registry an "enormous step in moving things forward." While he found parts of the questionnaire difficult to respond to, he said he's hopeful that feedback from users will steadily improve it.

"My message would be, you know, get in there and give it a try," he added. "Get in the system."

And that's exactly what I did.

In a past life, I did a short season with an engine crew and three full seasons with a handcrew, both based in southeast Idaho. I often worried about the long-term health implications, and would fruitlessly Google around in the postseason looking for insight.

Like Dutchick, I found it difficult to recall some details of seasons long past on the NFR questionnaire. But I did my best, and after about 30 minutes clicked "submit."

One more firefighter enrolled – many thousands to go.

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