Women Firefighters Biomonitoring Collaborative

Institution: University of California, Berkeley
Investigator(s): Rachel Morello-Frosch, Ph.D., M.P.H. - Heather Buren,  - Tony Stefani, AA -
Award Cycle: 2013 (Cycle 19) Grant #: 19UB-2900 Award: $788,489
Award Type: SRI Request for Proposal (RFP)
Research Priorities
Etiology and Prevention>Etiology: the role of environment and lifestyle

Initial Award Abstract (2013)

Introduction: San Francisco women firefighters approached environmental health advocates in 2012 with concerns about multiple cases of premenopausal breast cancer among their ranks. Together, they discussed the need to understand breast cancer risk factors among women firefighters, particularly with regard to potential chemical exposures on the job. These groups recruited environmental health researchers from UC Berkeley and Silent Spring Institute to develop a study to address concerns about occupational exposures by measuring levels of chemicals in the bodies of women firefighters. The team is especially interested in chemicals with data suggesting potential links to breast cancer, given the concerns about breast cancer among women firefighters. This study would address the San Francisco firefighters’ concerns and add to the knowledge about women’s occupational exposures in general, an area which has been dramatically understudied.

Question(s) or hypotheses: We have three primary research questions: (1) Are levels of chemicals, including chemicals that research suggests may increase risk of breast cancer, higher among women firefighters than other women? (2) Are there other, previously unknown, chemical exposures that are higher among women firefighters compared to female non-firefighter controls? (3) Are there early indicators of biological changes associated with chemical exposures and exposure to chronic night shift work, including disruption of thyroid hormones (that sustain the body’s metabolic functions); lower levels of melatonin (a hormone that regulates sleep/wake cycles); and changes in telomere length (a biomarker of cellular aging)?

General methodology: We will recruit 80 women firefighters from the SF Fire Department (SFFD) and 80 women from other civil services. We will interview and collect blood and urine samples from each woman. We will measure exposures to certain chemicals with potential links to increased breast cancer, including products of combustion that firefighters may frequently encounter. We will also use an innovative method called Time of Flight to measure chemicals that we might not otherwise suspect to find in the participants. This may reveal chemical exposures that have never before been measured. We will select a subset of these chemicals and conduct further analyses to verify levels among firefighters and the control group. Finally, we will measure early indicators of adverse health outcomes, including changes in thyroid hormones, melatonin levels, and altered telomere length, which may be related to chemical exposure or night shift work. Combined results from all participants will be made available to all participants, firefighters and civil employees. Individual results will be made confidentially available to individual participants who want them.

Innovative elements: To our knowledge, this is the first study to assess chemical exposures, including exposure to chemicals linked to breast cancer, among women firefighters. The SFFD has one of the largest populations of women firefighters (approximately 225) in the nation, and is the ideal fire service for this study. We will measure chemicals we suspect will be elevated and scan for other chemicals using innovative Time of Flight technology. Time of Flight technology is a non-specific technique that scans the sample for chemicals based on their molecular weight; and therefore allows for the detection of chemicals that were not known or predicted to be elevated. As a result, our project will apply one of the newest tools available for biomonitoring.

Community involvement: Firefighters initiated this study and have been involved in every step of developing the research questions and study design. They will continue to be engaged throughout the research process, and we have already secured $60,000 from the firefighters’ union to ensure the capacity to educate and disseminate research findings throughout the SFFD, to other firefighters across the nation, and to decision-makers. In addition, the study has already garnered local media coverage, illustrating the potential for this project to ignite public interest.

Final Report (2017)

The goal of the Women Firefighters Biomonitoring Collaborative (WFBC) is to measure and compare chemical exposures between San Francisco Fire Department women firefighters and non-firefighter civilian employees of the City and County of San Francisco. We used targeted and non-targeted approaches to explore and quantify chemical exposures (Aim 1); Will continue to evaluate the impact of chemical exposure and chronic night shift work and on early biomarkers of effect (Aim 2); And, report back individual results to participants who want them (Aim 3).

We recruited over 170 women in to the study and collected biospecimen samples from 86 firefighters and 84 non-firefighters. For the targeted analysis, the Gerona Lab developed the method for measuring perfluoroalkyl substances (PFAS) and quantified 12 PFAS analytes. All participants in the study had multiple congeners of PFAS in their bodies. In statistical analyses, we found higher levels of two PFAS analytes in firefighters compared to non-firefighters: perfluorohexane sulfonate (PFHxS) and perfluorononanoic acid (PFNA). A poster of PFAS results was presented at the 2016 American Industrial Hygiene Association conference (AIH). We are currently preparing a manuscript for publication.

We completed the non-targeted scan of participants’ serum samples. Non-targeted analysis detects molecular weights, retention times, and peak areas of all the compounds present in the serum. The results from this scan were then matched to a custom-made library of over 700 compounds. We identified 620 chemicals matching 300 molecular weights in our samples. From those identified we then selected 19 chemicals to validate based on the following criteria: 1) higher peak areas in FF samples, 2) higher detection frequency in FF samples, 3) concern with regard to breast cancer, 4) genotoxicity, and 5) not currently measured in large biomonitoring studies. 13 compounds were confirmed and 12 are being quantified in participants’ samples. The results of the non-targeted analysis were presented at the 2017 International Society for Exposure Science (ISES) in Durham, North Carolina and is being prepared for publication.

We will report back individual results to participants who want them. We will use the Digital Report Back Interface (DERBI) developed through a partnership between Silent Spring, Harvard, Northeastern University and UC Berkeley. We held two focus groups in year 3. We met with study participants and solicited feedback on how the results were presented through DERBI. Participants liked the interface and suggested improvements for presenting results and how to inform exposure prevention. Computer engineers at Silent Spring Institute have updated DERBI with the suggestions. We will begin to roll out individual level results to participants who requested them in early 2018. We will report back PFAS compounds and those chemicals confirmed and quantified form the non-targeted analysis. The rest of the chemical results will be made available to participants via DERBI as they are ready.

The WFBC continues to foster partnerships and engage the broader community on the health impacts of environmental chemicals in firefighting. Over the past 4 years, community and advocacy partners have presented over 70 times at conferences, meetings, and in the community. Firefighters and advocacy partners testified to representatives at the state and national level, and developed a safety and exposure prevention training entitled: “extinguishing breast cancer from the fire-service.” This training is a collaboration with Commonweal, the Breast Cancer Fund and the Blue Green Alliance. Firefighter advocates and scientist partners have collaboratively presented the training to the 2016 new recruits in the San Francisco Fire Department, as well as to firefighter groups in Arizona, Florida, New Hampshire and Washington this past year (2017). In addition to the training, community research collaboration (CRC) partners developed and starred in “gross decontamination” safety video and there are efforts underway to implement the safety training in SFFD.