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: $833,945
Award Type: SRI Request for Proposal (RFP)
Research Priorities
Etiology>Environment and gene/environment interactions: nature vs. nurture

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.

Progress Report 1 (2014)

The Women Firefighters Biomonitoring Collaborative (WFBC) examines the following questions: 1) Are levels of potential breast carcinogens, such as PBDEs, PFCs and PAHs, higher among women firefighters compared to non-firefighter women? 2) Are there other, previously unknown, chemical exposures identified using non-targeted analytical techniques that are higher among women firefighters compared to other female workers who are not firefighters? 3) Is exposure to chemicals or to chronic night shift work associated with early health effect biomarkers, such as thyroid hormone disruption, altered melatonin levels and shorter telomere length?

During Year 1 of the WFBC, we successfully established the essential infrastructure and staffing necessary to commence participant recruitment, sample collection and data analysis. Our research team co-developed study protocols including our recruitment strategy, interview questionnaires, sampling methods, and finalized a list of analytes before launching the WFBC study. Our goal is to recruit 160 participants (80 women firefighters and 80 female controls among office workers from the City of San Francisco). We initiated outreach in November 2013 and recruitment in May 2014 through strategies such as online promotion (including launching the WFBC website), informational meetings, tabling at citywide events and solicitation by the SFFD Chief to all SF City and County workers. As of July 20, 2014, we have recruited 78 firefighters and 87 office workers, and have further enrolled and interviewed 22 firefighters and 36 controls. Our University of California, San Francisco (UCSF) collaborator, Dr. Roy Gerona, has completed methods development for the study’s BDE flame retardants and PFC analytes and is poised to begin analytical work for the remaining flame retardants and PAHs. UCSF’s Dr. Michael McMaster has similarly finalized methods for telomere, thyroid and melatonin analysis. We additionally formed and convened the first meeting of our Scientific Advisory Group in March 2014, in which we presented the study aims and received feedback on study protocols. Our team is currently developing the strategy for results communication and dissemination to various stakeholders, including to firefighters, decision-makers, the media, scientists, and the broader public. Outreach strategies will include the WFBC website, media events that highlight the unique health issues and chemical exposures faced by firefighters and presentations to diverse audiences. On September 29, 2014 we will host a media and policy training for all collaborators. The training will be led by Margie Kelly, a distinguished chemicals policy communication expert. Finally, we are also assessing some of the scientific and ethical challenges of results communication in biomonitoring research to inform our report-back strategies to WFBC participants, and we recently submitted a paper on this issue to Environmental Research. Barriers to our progress have mainly been bureaucratic, including delays in getting CBCRP funds transferred to UCB, and subawards issued to collaborators. These delays have not affected our ability to meet our timeline milestones, however. Given the early stage of our study, we currently do not have scientific results to report, but we are encouraged by our continued progress and achievements thus far.