What can firefighters do to reduce their risk of developing pancreatic cancer?

Firefighters and Pancreatic Cancer Risk Reduction

Primary Prevention Strategies

Firefighters should prioritize smoking cessation, maintaining a healthy weight, and limiting alcohol intake, as these are the most modifiable risk factors for pancreatic cancer that can be directly controlled. 1

Tobacco Exposure

• Complete smoking cessation is essential, as tobacco carries a relative risk of 2.0 and accounts for 11-32% of pancreatic cancer cases. 1
• Firefighters face dual tobacco exposure: personal smoking habits and occupational smoke inhalation during fire suppression activities. 1
• Even though occupational chemical exposures (including combustion products) are recognized risk factors, eliminating personal tobacco use remains the single most impactful modifiable behavior. 1

Weight Management and Diet

• Maintain a body mass index in the normal range, as obesity carries a relative risk of 1.2-1.5 and contributes to 3-16% of cases. 1
• Reduce red meat consumption, which has a relative risk of 1.1-1.5 and accounts for 2-9% of cases. 1
• Increase fruit and vegetable intake, as low consumption is associated with up to 12% of cases. 1
• These dietary modifications are particularly important given the shift work and irregular eating patterns common in firefighting. 1

Alcohol Consumption

• Limit alcohol intake to avoid heavy consumption, as this carries a relative risk of 1.1-1.5 and accounts for 9% of pancreatic cancer cases. 1
• Heavy alcohol use also increases risk of chronic pancreatitis, which itself is an independent risk factor for pancreatic cancer. 1

Occupational Considerations

Chemical Exposure Awareness

• Firefighters have documented occupational exposure to chemicals associated with increased pancreatic cancer risk, including benzidine and other combustion byproducts. 1
• Use proper personal protective equipment consistently, including self-contained breathing apparatus during all fire suppression and overhaul activities, not just active firefighting. 1
• Decontaminate thoroughly after each exposure to minimize absorption of carcinogenic compounds through skin contact. 1

Metabolic Health Monitoring

• Monitor for new-onset diabetes mellitus, particularly after age 50, as this can be an early warning sign of pancreatic cancer with a relative risk of 1.4-2.2. 1
• Firefighters should undergo regular health screenings that include fasting glucose or HbA1c testing. 1
• New-onset diabetes in individuals over 50 years warrants additional investigation, as 0.4-0.8% will be diagnosed with pancreatic cancer within 3 years. 1

Genetic Risk Assessment

Family History Evaluation

• Firefighters with two or more first-degree relatives with pancreatic cancer should seek genetic counseling, as familial pancreatic cancer accounts for 4-10% of cases. 1
• Those with known hereditary syndromes (BRCA2, PALB2, CDKN2A mutations, Lynch syndrome, Peutz-Jeghers syndrome) require specialized surveillance. 1, 2
• Screening should begin at age 50 or 10 years earlier than the youngest affected relative in high-risk individuals. 1, 2

Surveillance for High-Risk Individuals

• Annual endoscopic ultrasound (EUS) and/or pancreatic MRI are the preferred surveillance methods for those meeting high-risk criteria. 1
• Surveillance programs have demonstrated higher resectability rates and improved long-term survival when cancers are detected early. 1, 2
• High-risk firefighters should enroll in investigational screening registries at expert centers. 1

Critical Pitfalls to Avoid

• Do not dismiss new-onset diabetes as simply occupational stress-related; it requires thorough evaluation in firefighters over 50. 1, 2
• Do not rely solely on CA 19-9 or other biomarkers for screening, as they lack sufficient sensitivity and specificity for asymptomatic individuals. 3
• Do not delay genetic counseling if family history suggests hereditary risk, even if occupational exposures seem like the primary concern. 1
• Do not assume that maintaining fitness for duty is sufficient; specific attention to pancreatic cancer risk factors is necessary given occupational exposures. 1

Summary of Actionable Steps

For all firefighters:

• Stop smoking completely 1
• Maintain healthy body weight 1
• Limit alcohol consumption 1
• Increase fruit and vegetable intake while reducing red meat 1
• Use proper PPE and decontamination protocols consistently 1
• Monitor for new-onset diabetes after age 50 1

For firefighters with family history:

• Seek genetic counseling if ≥2 first-degree relatives have pancreatic cancer 1
• Enroll in surveillance programs at expert centers 1
• Begin annual EUS/MRI screening at age 50 or earlier based on family history 1, 2