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Case studies on Aqueous Film-Forming Foam (AFFF) help health agencies and regulatory boards understand the impact of this toxic fire suppressant.
While the manufacturers of legacy firefighting foams did not disclose the truth about these fire suppressants, many research institutes are working to get the facts right. Studies are generating data that draw a connection between the firefighter’s exposure to foams and adverse health conditions. Not only does this help supply evidence for Multidistrict litigations (MDLs), but it also helps support the creation of regulations to protect future firefighters.
Studies Connecting Cancer and PFAS Exposure
Several types of case studies are initiated to help researchers understand the link between cancers and PFAS exposure. Currently, there are several large-scale epidemiological studies in process. Cohort case studies provide high-quality evidence on the relationships between exposure to PFAS and health conditions, but following several hundred or thousands of participants over an extended period takes time to complete. Many research institutes are also performing meta-analyses on past case studies to find correlations between AFFF exposure and diseases. These are some of the influential ongoing and concluded case studies:
National Cancer Institute (NCI) Epidemiology Studies
National Cancer Institute’s Division of Cancer Epidemiology & Genetics (DCEG) maintains an ongoing portfolio of research to identify cancer types associated with exposure to ‘forever’ chemicals. This institute is actively evaluating correlations between PFAS and kidney cancer, testicular cancer, and other diseases.
Examination and testing are ongoing, but early evidence helped inform the evaluation of PFAS as possible and probable human carcinogens by the International Agency for Research on Cancer (IARC). Many of these PFAS studies are firsts, including the NCI’s testicular cancer study of active-duty Air Force servicemen.
Study of Testicular Cancer in Military Men
Researchers studied the blood of thousands of U.S. Air Force men who worked as firefighters. This federal study concluded that airmen with testicular cancer had higher serum levels of PFOS than those who had not been diagnosed with cancer. This study also found evidence that firefighting, rather than living on military grounds, led to the strongest correlation between cancer and the airmen. The National Cancer Institute and the Uniformed Services University of Health Sciences performed the initial study that will certainly motivate continued research.
FEMA-Funded Fire Fighter Cancer Cohort Study (FFCCS)
The FFCCS research project was established in 2016. The long-term goal of FFCCS is to follow 10,000 firefighters over a 30-year observation period. This study will collect and implement epidemiologic surveys, biomarkers, and data on carcinogenic exposures and health effects. This national research project includes a sub-project focused solely on firefighters’ exposure to PFAS.
Studies on Environmental Contamination
Handling a fire extinguisher to dispense AFFF isn’t the only way firefighters come into contact with PFAS. Firefighting foam is a pollutant to the environment and the facilities that store, use, and discharge the chemicals. These studies examine the effects of community contamination on firefighters:
NIOSH Research on PFAS
The National Institute for Occupational Safety and Health (NIOSH) researches workplace conditions and sources of exposure to make recommendations for preventing work-related injuries and illnesses. The NIOSH began investigating PFAS in 2004, starting with examining dermal absorption of PFOA, a widely used forever chemical. This research expanded to include toxicological studies and an evaluation of community exposure in workplaces; firefighting was one of the occupations identified for its elevated exposure to PFAS, as compared to the general public. This ongoing research will help NIOSH develop analytical methods for measuring PFAS exposure in the workplace.
PFAS Studies on Epigenetic Aging
The Journal of Occupational and Environmental Medicine published a study on the relationship between firefighters’ exposure to PFAS from environmental sources and premature epigenetic aging, which refers to the speed at which a body ages on a cellular level. Changes to one’s epigenetic age can lead to health risks such as cancer. The study found evidence that elevated PFAS concentrations in test subjects’ serum are associated with accelerated epigenetic aging.
The IARC Evaluations and Case Studies
The International Agency for Research on Cancer (IARC) published a press release in July 2022 announcing the results of an evaluation of the occupational exposure of firefighters. The IARC’s Working Group (consisting of 25 international experts and 3 invited specialists, from 8 countries) reviewed cancer studies and mechanistic studies in humans to determine the effects of firefighting as an occupation on a person’s health. The review concluded that occupational exposure as a firefighter is carcinogenic to humans (Group 1). The designation of Group 1 means sufficient evidence was found to support the rationale that the firefighting occupation causes and is positively associated with certain cancers.
In November 2023, the IARC published its initial review of the carcinogenicity of PFOA and PFOS, two forever chemicals found in legacy versions of AFFF. This study evaluated PFOA as carcinogenic to humans (Group 1), and PFOS was evaluated as possibly carcinogenic to humans (Group 2B). Both findings were made based on strong mechanistic evidence. PFOA was originally evaluated in 2014 and classified as possibly carcinogenic to humans (Group 2B) but more recent studies found stronger associations between exposure and cancer, which led to its new designation.