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. 2025 Aug 23;69(8):791–797. doi: 10.1093/annweh/wxaf048

Wildland firefighter exposure and female cancer risk: currently available evidence

Kathleen Navarro DuBose 1, Megan Saylors 2, Pujeeta Chowdhary 3, Jessica Trowbridge 4,✉
PMCID: PMC12463555  PMID: 40850938

Abstract

The James M. Inhofe National Defence Authorization Act for Fiscal Year 2023 established that certain illnesses and diseases are to be deemed as proximately caused by employment in federal fire protection activities. However, cancers affecting female wildland firefighters were not included on this list and are recommended for further evaluation. We present the best available scientific evidence for the risk of breast and gynaecological cancers associated with exposures that are commonly measured in the wildland fire environment, including benzene, polycyclic aromatic hydrocarbons, and particulate matter. Epidemiology and experimental studies assessing these exposures have reported an increased risk for female breast and gynaecological cancers in other occupations or from indoor sources and the ambient environment (ie air pollution). Currently, there are 29 individual states in the United States that have laws that establish a presumption that female cancers contracted by firefighters are the result of occupational exposure. We highlight the link between common carcinogen exposures measured in the wildland fire environment with the risk of female cancers, which should be considered when evaluating the scientific evidence available for the inclusion of these cancers to be deemed as proximately caused by wildland firefighting.

Keywords: breast cancer, gynaecological cancers, particulate matter, wildfire, wood smoke

Introduction

Over the last decade, wildfire seasons across the United States have been characterized by increased frequency, intensity, and duration of fires, resulting in loss of life and property ( WFMMC, 2023 ). Wildland firefighters (WLFFs) respond to these wildfires and perform arduous work under harsh conditions in remote locations. Through their job, WLFF’s face many physical risks and hazards, including exposure to carcinogens from smoke, ash, and dust. Carcinogenic exposures evaluated for WLFFs include: acetaldehyde, acrolein, benzene, diesel exhaust, ethylbenzene, formaldehyde, heavy metals, polycyclic aromatic hydrocarbons (PAHs), particulate matter (PM), crystalline silica, styrene, and in some geographic locations asbestos and radionuclides (Wolfe et al. 2004; Ward et al. 2012; Adetona et al. 2016; Viner et al. 2018). In addition to experiencing exposure to carcinogens on the firelines (i.e. when fighting fire directly), WLFFs may also be exposed while off the fireline at incident command posts (where the incident management teams work and where fire personnel are logistically supported and sleep), through limited access to decontamination methods, (eg showers or laundering facilities) and may additionally be exposed to exhaust (including diesel another source of carcinogenic air pollution) from vehicles and generators (Navarro et al. 2019; Reinhardt and Broyles 2019; Cherry et al. 2022). WLFFs are also exposed to many of the same exposures while conducting prescribed burns, where personnel intentionally ignite areas with low-intensity fire for land management purposes (West et al. 2024).

In December 2022, the James M. Inhofe National Defence Authorization Act for Fiscal Year 2023 (FY23 NDAA) was signed into law (NDAA 2022). This included Section 5305, Fairness for Federal Firefighters and established that certain illnesses and diseases are to be deemed as proximately caused by employment in federal fire protection activities, and employees do not need to submit additional evidence of specific exposures or medical evidence addressing causal relationship when filing a workers’ compensation case. The FY23 NDAA listed: bladder, brain, colorectal, oesophageal, kidney, leukaemias, lung, mesothelioma, multiple myeloma, non-Hodgkin lymphoma, prostate, skin, testicular, and thyroid cancer. Breast and gynaecological cancers were not included on this list; however, the law states that within three years of enactment, the Secretary of Labour shall “evaluate the best available scientific evidence of the risk to an employee in fire protection activities of developing breast, gynaecological cancers….”

The federal wildland firefighting workforce includes approximately 18,700 employees from the Bureau of Indian Affairs, Bureau of Land Management, the National Park Service, and the U.S. Fish and Wildlife Service of the Department of the Interior (DOI) and the Department of Agriculture Forest Service (USFS). USFS has estimated that the wildland fire workforce is approximately 13% to 15% female (USFS 2024a). Since 2007, DOI has averaged a wildland fire workforce of 20% female ( DOI, 2024). The US Government Accountability Office identified the following barriers to recruitment and retention of female WLFFs: the arduous nature of the work, a homogenous workforce that may lead to a feeling of unacceptance, loss of special retirement benefits after a break in service (such as for family caregiving duties), and experiencing sexual harassment. However, there are ongoing efforts to increase the number of female WLFF, including targeted recruitment, training programs and crews specifically for female WLFFs (GAO 2023; USFS 2024b).

The incidence of breast cancer in females is approximately 1 in 8, with numerous risk factors identified, including exposure to mammary carcinogens, endocrine disruptors, and shift work (Buermeyer et al. 2020). Though female WLFF comprise up to 20% of the federal wildland firefighting workforce, it is important to continue to understand their health risks from occupational exposures. In this article, we present the available scientific evidence for the risk of female breast and gynaecological cancers from exposure to commonly measured carcinogens (benzene, PAHs, and PM in the wildfire environment).

Exposures associated with female breast and gynaecological cancers

Benzene

Benzene is classified as a Group 1 (carcinogenic to humans) carcinogen by IARC and has been measured in wildfires and prescribed fires (Loomis et al. 2017; West et al. 2024). Exposure assessments conducted on WLFFs have measured exposures that exceed occupational exposure limit (OEL)s set by the Occupational Safety and Health Administration (1 ppm). Romagoli et al. 2014 reported a range of personal samples collected of 8.5 to 17 ppm, while Barboni et al. 2010 reported one area sample to be 10.21 ppm during prescribed fires in France (Barboni et al. 2010; Romagnoli et al. 2014).

Numerous studies have reported that exposure to benzene in other occupational and ambient settings is associated with an increased risk of female breast and genital cancer. A 2024 systematic review and meta-analysis reported a summary relative risk (RR) of 1.17 (95% confidence interval [95% CI] 1.06 to 1.28) for ever-benzene exposure and 1.35 (95% CI: 1.06 to 1.72) for high-level benzene exposure (Seyyedsalehi et al. 2024). Results from female participants in the Multiethnic Cohort Study in southern California reported an increased risk of invasive breast cancer (hazard ratio [HR]: 1.32, 95% CI: 1.24 to 1.41) from ambient air benzene exposure estimated from the National-Scale Air Toxics assessment (Heck et al. 2024). An earlier study from the same cohort also observed that outdoor ambient benzene exposure (median: 0.94 ppb) was associated with an increased risk of breast cancer (per 1 ppb HR: 1.40, 95% CI: 1.24 to 1.58; Ihenacho et al. 2022). In addition, a recent meta-analysis reported an association between occupational ever-benzene exposure and female genital cancer (ovarian, uterine, cervical). Shah et al. 2024 calculated a summary RR for ever-benzene exposure of 1.22 (95% CI: 1.03 to 1.44) and 1.09 (95% CI: 0.92 to 1.29) and 1.69 (95% CI: 1.18 to 2.4) for RR for female genital cancers incidence and mortality, respectively (Shah et al. 2024).

Polycyclic aromatic hydrocarbon

PAHs have been measured in the air, in urine and on the skin of WLFFs at wildfires, prescribed fires and at incident command posts (Navarro et al. 2017, 2019; Cherry et al. 2022). Several of these measured PAHs have been classified as known (Group 1), probable (Group 2A), and possible (Group 2B) human carcinogens by IARC including benz[a]anthracene (2B), benzofluoranthenes (2B), benzo[b]fluoranthene (2B), benzo[j]fluoranthene (2B), benzo[k]fluoranthene (2B), benzo[c]phenanthrene (2B), benzo[a]pyrene (1), chrysene (2B), cyclopenta[c, d]pyrene (2A), dibenz[a,h]anthracene (2A), indeno[1,2,3-cd]pyrene, and naphthalene (2B; Jameson 2019). Naphthalene has the highest reported exposure concentrations of all measured PAHs, with mean exposure concentrations from personal samples ranging from 669 to 3,189 ng/m3; while benzo[a]pyrene personal exposure means ranged from 7 to 15 ng/m3 (Materna et al. 1992; Navarro et al. 2017). Biomarkers of PAH exposure detected in the urine of WLFFs working on wildfires and prescribed fires include: 1-hydroxynaphthalene, 2-hydroxynaphthalene, and 1-hydroxypyrene (Robinson et al. 2008; Oliveira et al. 2016; Adetona et al. 2017; Cherry et al. 2019). Lastly, two Canadian studies reported higher mean naphthalene dermal exposures post-shift compared to pre-shift on the hand, throat and chest of WLFFs (Cherry et al. 2021, 2022).

PAH exposure from indoor and outdoor exposure sources and in the workplace has been associated with an increased breast and ovarian cancer risk. In a large prospective cohort study of breast cancer-free women in the United States, there was a modestly higher breast cancer risk (HR: 1.11; 95% CI: 1.01 to 1.22) for those having an indoor wood-burning stove/fireplace in the place where they lived the longest as an adult (White and Sandler 2017). Another study of a population-based sample of women in Long Island, NY observed a 30% to 50% increase in breast cancer incidence from common PAH exposure sources that included: active smoking, residential environmental tobacco smoke from spouse, grilled/smoked meat intake, stove/fireplace use (White et al. 2016). When examining outdoor air pollution exposure, a recent study observed a positive association between fluoranthene exposure and breast cancer in a national sample of premenopausal women (adjusted odds ratio: 1.59; 95% CI: 1.11, 2.29; Hinton et al. 2024). From workplace exposures, those occurring prior to age 36 increased breast cancer risk by 75% (Labrèche et al. 2010). Lastly, in an analysis of participants in the United States National Health and Nutrition Examination Survey, PAH exposure (measured through urinary biomarkers) was associated with an elevated ovarian cancer risk (measured through human epididymal secretory protein 4, a crucial ovarian cancer biomarker; Liang et al. 2022).

In addition, there is mechanistic evidence to support this association. PAHs have been reported to mimic and disrupt endogenous estrogens and have been shown to bind and alter DNA (creating DNA adducts), both pathways can increase the risk of breast cancer (Santodonato 1997; Gammon et al. 2002). More specifically, Gammon et al. 2008 reported that women with higher concentrations of PAH-DNA adducts in their blood were 50 per cent more likely to experience breast cancer (Gammon and Santella 2008).

Particulate matter

PM of varying aerodynamic diameter sizes (PM10, PMrespirable, PMtotal) are classified by IARC as a Group 1 carcinogen and the most common exposure measured on WLFFs on wildfires, prescribed fires and in ICPs (IARC 2016; Navarro et al. 2019; Reinhardt and Broyles 2019). Mean concentrations of PM2.5-4 from exposure assessments performed over the last 10 years at wildfire and prescribed fires were 1.7 times the National Wildfire Coordinating Group (NWCG) OEL (0.7 mg/m3). While no mean concentration was above the OSHA PEL, the NWCG recommended their OEL to account for the longer work shift, arduous work demands, and the exposure to multiple chemicals in smoke. Maximum concentrations reported were up to 24.5 times the NWCG OEL and 3.2 times the OSHA PEL (Navarro 2020). High concentrations of PM at fire camps can result in “Unhealthy” to “Hazardous” conditions (PM2.5 Concentration of 55.5 to 150.4 and 250.5 to 500.4 μg/m3, respectively), as defined by the U.S. Environmental Protection Agency Air Quality Index (Navarro and Vaidyanathan 2020).

The number of studies contributing evidence for exposure to PM2.5 and breast and ovarian cancer risk continues to grow. Although three recent meta-analyses did not find an overall association with PM2.5 and breast cancer, a 2023 pooled analysis of 6 cohorts from Europe reported breast cancer incidence (HR: 1.06; 95% CI: 1.01 to 1.11) associated with a 5 μg/m3 increase in PM2.5 exposure (Gabet et al. 2021; Guo et al. 2021; Wei et al. 2021; Hvidtfeldt et al. 2023). A 2024 study by White et al. reported that a 10 μg/m3 increase in PM2.5 exposure was associated with overall breast cancer incidence (HR: 1.10; 95% CI: 1.04 to 1.17), as well as for estrogen-receptor positive tumour incidence in a large prospective US cohort (White et al. 2024). In an ecological study, higher ambient PM2.5 concentrations at the county-level were associated with ovarian cancer. Increases in 5-year PM2.5 concentrations was significantly associated with overall annualized ovarian cancer incidence (RR: 1.11 per 10 μg/m3 increase, 95% CI: 1.06 to 1.16) and when limited to epithelial cell tumors (RR: 1.12 per 10 μg/m3 increase, 95% CI: 1.08 to 1.17; Kentros et al. 2024).

Growing evidence for female firefighters’ cancer risk

Evidence of the carcinogenic risk for firefighters continues to grow. A 2024 systematic review identified 49 papers that measured exposures to 31 carcinogens in the air, in urine and on the skin of WLFFs. This review establishes consistent evidence that WLFFs are regularly exposed to multiple carcinogens at varying concentrations across most work tasks performed on wildfires and prescribed fires and at incident command posts (West et al. 2024). In 2022, the International Agency for Research on Cancer (IARC) reclassified occupational exposure as a firefighter as carcinogenic to humans (Group 1; IARC Working Group on the Identification of Carcinogenic Hazards to Humans 2023). This update was done 12 years after the initial IARC evaluation and based on the growing body of evidence linking occupational exposures during firefighting and cancer (IARC 2010). Specifically, they identified sufficient evidence for an association with mesothelioma and bladder cancer and limited evidence for cancers of the colon, prostate, and testis, as well as for melanoma of the skin and non-Hodgkin lymphoma. However, there was limited and inconsistent epidemiological data on breast cancer and the working group was unable to calculate a meta-rate ratio. The updated IARC monograph on firefighting included evidence from multiple studies on WLFFs that provided the mechanistic evidence of carcinogenicity from exposures to wildfires and prescribed fires, reporting increases in inflammation and oxidative stress (Adetona et al. 2016, 2017; Main et al. 2020).

Even more recently, Cardona et al. 2024 conducted a systematic review and found strong evidence of elevated firefighting exposures (benzene, PAHs, acetaldehyde, styrene, dioxin-like compounds, polybrominated diohenyl ether flame retardants, replacement flame retardants, per- and polyfluoroalkyl substances, and polychlorinated biphenyls) that are associated with breast cancer risk in epidemiology and experimental studies (Cardona et al. 2024). Although this study focused only on breast cancer and presents information on many exposures specific to structure firefighters, the authors present a strong evidence base for the association between PAH exposure and breast cancer risk.

Past studies of structural firefighters suggest an association between firefighting and the risk of cancer for female firefighters. A study of Florida firefighters calculated a significantly increased incidence of overall rates all, cervical and thyroid cancer and Hodgkin disease in female firefighters (Ma et al. 2006). In a large cohort study of structural firefighters across 3 major cities in the United States, Daniels et al. 2014 reported that the overall cancer incidence and number of breast cancers for female firefighters were elevated but not significant (Daniels et al. 2014). A similar finding of elevation of breast cancer mortality was reported in a follow-up study adding 7 years to the cohort, but also not statistically significant (Pinkerton et al. 2020). However, the authors do note that results could be affected by small samples and findings on female outcomes should be interpreted with caution. In addition, other studies have excluded female firefighters from analysis of cancer risk due to their small sample sizes (Pukkala et al. 2014; Marjerrison et al. 2022).

Breast cancer can also affect male firefighters, as demonstrated in a study conducted on firefighters from 1972 to 1999 that reported a 7.4-fold higher risk of dying from breast cancer compared to the general male population in Florida (Ma et al. 2005). Another study on male Australian firefighters found a statistically significant increase in breast cancer incidence among full-time firefighters who had been on the job for 20 years or more (Glass et al. 2016). These results are notable given the rarity of male breast cancer and may support the notion that occupational exposures increase the risk of this condition (Ly et al. 2013).

Recognizing these increased risks, many individual states have passed laws that establish a presumption that different types of cancers developed by firefighters are the result of firefighting-related exposure (FRCE 2022). Currently, there are 29 states in the United States that provide workers’ compensation coverage for breast and female cancers. Twenty-seven states provide coverage for breast cancer, 9 states specify cervical and/or ovarian cancer, 2 states specify uterine cancer, 4 states specify reproductive tract or system cancer, and 3 states specify genitourinary and/or gynaecological cancers.

There are additional risk and protective factors that should be considered when evaluating the risk of gynaecological cancers for female fighters. Exposure to female hormones (eg hormone replacement), endocrine-disrupting chemicals, weight and obesity, and genetic mutations or a family history may increase the risk of breast and ovarian cancer (Rodgers et al. 2018; Fitzpatrick et al. 2023; CDC 2024; O’Brien et al. 2025). In addition, WLFFs can work night shifts which is a probable carcinogen identified by IARC (Ward et al. 2019). There are also protective factors that may lower the risk of breast cancer that include: having a full-term pregnancy, first pregnancy before the age of 30, breastfeeding and being physically active (likely to be higher for female WLFF; CDC 2024). Although hard to measure or assess, these factors should be considered when designing epidemiological studies among female firefighters, especially when comparing rates among the general population.

Conclusions

Studies demonstrate that exposures commonly measured in the wildland fire environment are associated with increases in female breast, ovarian, uterine, and cervical cancer. Although these exposures and outcomes are not directly measured on WLFFs, these outcomes have been studied across many different exposure sources, including occupational, indoor and outdoor environments. Of the female cancers associated with these exposures, breast cancer is the most studied outcome.

While direct evidence for cancer risk from studies of female WLFFs will be difficult and may take many years, precluding prevention efforts, available epidemiology and toxicology evidence supports the link between occupational exposures in WLFFs and breast and gynaecological cancers. After submission of this commentary, the U.S. Department of Labor (DOL) issued a Federal Employees’ Compensation Act Bulletin (25-01) on January 10, 2025, indicating that firefighters are at increased risk of the following cancers not previously covered by the NDAA: breast cancer, cervical cancer, uterine cancer, ovarian cancer and basal cell carcinoma (DOL 2025). While these conditions are now deemed “high risk” and firefighters may submit worker compensation claims for expedited review, this designation and process are separate from those established under the FY23 NDAA. To be added to the list of covered conditions established by Congress in the FY23 NDAA, the DOL Office of Worker Compensation Program must pursue changes through the rule-making process. Although gynaecological cancers are now deemed “high risk” by DOL, there is a continued need to consider female firefighter health risks from occupational exposures in future prevention efforts, evaluations, and regulations.

Contributor Information

Kathleen Navarro DuBose, United States Department of the Interior, Office of Wildland Fire, Boise, ID, 83705, USA.

Megan Saylors, United States Department of Agriculture Forest Service, Pacific Northwest Region, Redmond, OR, 97756, USA.

Pujeeta Chowdhary, Breast Cancer Prevention Partners, San Francisco, CA, 94109, USA.

Jessica Trowbridge, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA 94143, USA.

Funding

Support for Dr Trowbridge was provided by core center grant P30-ES030284 from the National Institute of Environmental Health Sciences, National Institutes of Health.

Conflicts of interest statement

The authors declare no conflict of interest relating to the material presented in this Article. Its contents, including any opinions and/or conclusions expressed, are solely those of the authors.

Data availability

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Disclaimer

The findings and conclusions in this report are those of the author(s) and should not be construed to represent any official US Government determination or policy. This article was written and prepared by US Government employees on official time, and it is therefore in the public domain and not subject to copyright.

References

  1. DOL. 2025. Department of Labor Federal Employees’ Compensation Act Bulletin 25.01. https://www.dol.gov/agencies/owcp/FECA/regs/compliance/DFECfolio/FECABulletins/FY2025-2029. Accessed 15 July 2025.
  2. Adetona AM, et al. 2017. Impact of work task-related acute occupational smoke exposures on select proinflammatory immune parameters in wildland firefighters. J Occup Environ Med. 59:679–690. https://doi.org/ 10.1097/JOM.0000000000001053 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Adetona O, et al. 2016. Review of the health effects of wildland fire smoke on wildland firefighters and the public. Inhal Toxicol. 28:95–139. https://doi.org/ 10.3109/08958378.2016.1145771 [DOI] [PubMed] [Google Scholar]
  4. Barboni T, et al. 2010. Volatile and semi‐volatile organic compounds in smoke exposure of firefighters during prescribed burning in the Mediterranean region. Int J Wildland Fire. 19:606–612. https://doi.org/ 10.1071/wf08121 [DOI] [Google Scholar]
  5. Buermeyer N, Engel C, Nundelman J, Rasanayagam S, Sarantis H.. 2020. Paths to prevention the california breast cancer primary prevention plan. Breast Cancer Prevention Partners 1. https://www.bcpp.org/wp-content/uploads/2020/09/Paths-to-Prevention-California-Breast-Cancer-Primary-Prevention-Plan_September-2020.pdf [Google Scholar]
  6. Cardona B, Rodgers KM, Trowbridge J, Buren H, Rudel RA.. 2024. Breast cancer-related chemical exposures in firefighters. Toxics 12:707. https://doi.org/ 10.3390/toxics12100707 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. CDC. 2024. Breast cancer risk factors. Breast Cancer. https://www.cdc.gov/breast-cancer/risk-factors/index.html. Accessed. 15 July 2025. [Google Scholar]
  8. Cherry N, et al. 2019. Urinary 1-hydroxypyrene and skin contamination in firefighters deployed to the fort mcmurray fire. Ann. Work Expo. Health. 63:448–458. https://doi.org/ 10.1093/annweh/wxz006 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cherry N, et al. 2021. Exposure and absorption of PAHs in wildland firefighters: a field study with pilot interventions. Ann. Work Expo. Health. 65:148–161. https://doi.org/ 10.1093/annweh/wxaa064 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Cherry N, et al. 2022. Exposures to polycyclic aromatic hydrocarbons and their mitigation in wildland firefighters in two Canadian provinces. Ann. Work Expo. Health. 67:354–365. https://doi.org/ 10.1093/annweh/wxac085 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Daniels RD, et al. 2014. Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009). Occup Environ Med. 71:388–397. https://doi.org/ 10.1136/oemed-2013-101662 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. DOI. 2024. Department of the Interior Workforce Information. Office of Human Capital. [Google Scholar]
  13. Fitzpatrick D, Pirie K, Reeves G, Green J, Beral V.. 2023. Combined and progestagen-only hormonal contraceptives and breast cancer risk: A UK nested case–control study and meta-analysis. PLoS Med. 20:e1004188. https://doi.org/ 10.1371/journal.pmed.1004188 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. FRCE. 2022. Firefighter Presumptive Cancer Legislation In The United States. First Responder Center for Excellence. https://firstrespondercenter.org/wp-content/uploads/2023/08/Firefighter-Presumptive-Cancer-Legislation-in-the-US-Print-Individual-Pages4.pdf
  15. Gabet S, Lemarchand C, Guénel P, Slama R.. 2021. Breast Cancer Risk in Association with Atmospheric Pollution Exposure: A Meta-Analysis of Effect Estimates Followed by a Health Impact Assessment. Environ Health Perspect. 129:57012. https://doi.org/ 10.1289/EHP8419 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Gammon MD, et al. 2002. Environmental toxins and breast cancer on Long Island. I. Polycyclic aromatic hydrocarbon DNA adducts. Cancer Epidemiol Biomarkers Prev. 11:677–685. https://pubmed.ncbi.nlm.nih.gov/12163319/ [PubMed] [Google Scholar]
  17. Gammon MD, Santella RM.. 2008. PAH, genetic susceptibility and breast cancer risk: An update from the long island breast cancer study project. Eur J Cancer (Oxford, England : 1990) 44:636–640. https://doi.org/ 10.1016/j.ejca.2008.01.026 [DOI] [PubMed] [Google Scholar]
  18. GAO. 2023. Wildland Fire: Barriers to Recruitment and Retention of Federal Wildland Firefighters | U.S. Government Accountability Office. https://www.gao.gov/products/gao-23-105517
  19. Glass DC, Pircher S, Monaco AD, Hoorn SV, Sim MR.. 2016. Mortality and cancer incidence in a cohort of male paid Australian firefighters. Occup Environ Med. 73:761–771. https://doi.org/10.1136/oemed-2015-103467 [DOI] [PubMed] [Google Scholar]
  20. Guo Q, et al. 2021. Relationship between particulate matter exposure and female breast cancer incidence and mortality: a systematic review and meta-analysis. Int Arch Occup Environ Health. 94:191–201. https://doi.org/ 10.1007/s00420-020-01573-y [DOI] [PubMed] [Google Scholar]
  21. Heck JE, et al. 2024. Exposure to outdoor ambient air toxics and risk of breast cancer: The multiethnic cohort. Int J Hyg Environ Health. 259:114362. https://doi.org/ 10.1016/j.ijheh.2024.114362 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Hinton P, et al. 2024. Ambient polycyclic aromatic hydrocarbon exposure and breast cancer risk in a population-based Canadian case–control study. Cancer Causes Control. 35:1165–1180. https://doi.org/ 10.1007/s10552-024-01866-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Hvidtfeldt UA, et al. 2023. Breast Cancer Incidence in Relation to Long-Term Low-Level Exposure to Air Pollution in the ELAPSE Pooled Cohort. Cancer Epidemiol Biomarkers Prev. 32:105–113. https://doi.org/ 10.1158/1055-9965.EPI-22-0720 [DOI] [PubMed] [Google Scholar]
  24. IARC. 2010. Painting, firefighting, and shiftwork. IARC Monogr Eval Carcinog Risks Hum. 98:9. https://doi.org/ 10.1016/S1470-2045(07)70373-X [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. IARC. 2016. Outdoor Air Pollution. IARC Monogr Eval Carcinog Risks Hum. 109:9. https://doi.org/ 10.3322/caac.21632 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. IARC Working Group on the Identification of Carcinogenic Hazards to Humans. (2023) Occupational Exposure as a Firefighter. Lyon (FR): International Agency for Research on Cancer. ISBN 978-92-832-0131-1. [PubMed] [Google Scholar]
  27. Ihenacho U, et al. 2022. Abstract PO-170: Association between outdoor ambient benzene and invasive breast cancer incidence: the multiethnic cohort study. Cancer Epidemiol Biomarkers Prevent 31:PO–170. https://doi.org/ 10.1158/1538-7755.disp21-po-170 [DOI] [Google Scholar]
  28. Jameson CW. (2019) Polycyclic aromatic hydrocarbons and associated occupational exposures. In Baan R.A., Stewart B.W. & Straif K., editors. Tumour Site Concordance and Mechanisms of Carcinogenesis. Lyon (FR): International Agency for Research on Cancer. ISBN 978-92-832-2217-0. [PubMed] [Google Scholar]
  29. Kentros PA, et al. 2024. Ambient particulate matter air pollution exposure and ovarian cancer incidence in the USA: an ecological study. BJOG. 131:690–698. https://doi.org/ 10.1111/1471-0528.17689 [DOI] [PubMed] [Google Scholar]
  30. Labrèche F, Goldberg MS, Valois M-F, Nadon L.. 2010. Postmenopausal breast cancer and occupational exposures. Occup Environ Med. 67:263–269. https://doi.org/ 10.1136/oem.2009.049817 [DOI] [PubMed] [Google Scholar]
  31. Liang H-I, Cheng Y-W, Chang H-S, Su K-M, Chen W-L.. 2022. Exposure to polycyclic aromatic hydrocarbons and its relationship with increased expression of human epididymal secretory protein 4. Pol Arch Intern Med. 132:16195. https://doi.org/ 10.20452/pamw.16195 [DOI] [PubMed] [Google Scholar]
  32. Loomis D, et al. International Agency for Research on Cancer Monograph Working Group. 2017. Carcinogenicity of benzene. Lancet Oncol. 18:1574–1575. https://doi.org/ 10.1016/S1470-2045(17)30832-X [DOI] [PubMed] [Google Scholar]
  33. Ly D, Forman D, Ferlay J, Brinton LA, Cook MB.. 2013. An international comparison of male and female breast cancer incidence rates. Int J Cancer. 132:1918–1926. https://doi.org/ 10.1002/ijc.27841 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Ma F, et al. 2005. Mortality in Florida professional firefighters, 1972 to 1999. Am J Ind Med. 47:509–517. https://doi.org/ 10.1002/ajim.20160 [DOI] [PubMed] [Google Scholar]
  35. Ma F, Fleming LE, Lee DJ, Trapido E, Gerace TA.. 2006. Cancer incidence in Florida professional firefighters, 1981 to 1999. J Occup Environ Med. 48:883–888. https://doi.org/ 10.1097/01.jom.0000235862.12518.04 [DOI] [PubMed] [Google Scholar]
  36. Main LC, et al. 2020. Firefighter’s acute inflammatory response to wildfire suppression. J Occup Environ Med. 62:145–148. https://doi.org/ 10.1097/JOM.0000000000001775 [DOI] [PubMed] [Google Scholar]
  37. Marjerrison N, et al. 2022. Cancer incidence in sites potentially related to occupational exposures: 58 years of follow-up of firefighters in the Norwegian Fire Departments Cohort. Scand J Work Environ Health. 48:210–219. https://doi.org/ 10.5271/sjweh.4009 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Materna BL, Jones JR, Sutton PM, Rothman N, Harrison RJ.. 1992. Occupational exposures in california wildland fire fighting. Am Ind Hyg Assoc J. 53:69–76. https://doi.org/ 10.1080/15298669291359311 [DOI] [PubMed] [Google Scholar]
  39. Navarro K. 2020. Working in smoke: wildfire impacts on the health of firefighters and outdoor workers and mitigation strategies. Clin Chest Med. 41:763–769. https://doi.org/ 10.1016/j.ccm.2020.08.017 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Navarro K, Vaidyanathan A.. 2020. Notes from the field: understanding smoke exposure in communities and fire camps affected by wildfires— California and Oregon, 2020. MMWR Morb Mortal Wkly Rep. 69:1873–1875. https://doi.org/ 10.15585/mmwr.mm6949a4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Navarro KM, et al. 2019. Incident command post exposure to polycyclic aromatic hydrocarbons and particulate matter during a wildfire. J Occup Environ Hyg. 16:735–744. https://doi.org/ 10.1080/15459624.2019.1657579 [DOI] [PubMed] [Google Scholar]
  42. Navarro KM, Cisneros R, Noth EM, Balmes JR, Hammond SK.. 2017. Occupational exposure to polycyclic aromatic hydrocarbon of wildland firefighters at prescribed and wildland fires. Environ Sci Technol. 51:6461–6469. https://doi.org/ 10.1021/acs.est.7b00950 [DOI] [PubMed] [Google Scholar]
  43. NDAA. 2022. James M. Inhofe national defense authorization act for fiscal year 2023. H.R. 7776. https://www.congress.gov/bill/117th-congress/house-bill/7776/text [Google Scholar]
  44. O’Brien KM, et al. 2025. Hormone therapy use and young-onset breast cancer: a pooled analysis of prospective cohorts included in the Premenopausal Breast Cancer Collaborative Group. Lancet Oncol. 26:911–923. https://doi.org/ 10.1016/S1470-2045(25)00211-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Oliveira M, et al. 2016. Firefighters’ exposure biomonitoring: Impact of firefighting activities on levels of urinary monohydroxyl metabolites. Int J Hyg Environ Health. 219:857–866. https://doi.org/ 10.1016/j.ijheh.2016.07.011 [DOI] [PubMed] [Google Scholar]
  46. Pinkerton L, et al. 2020. Mortality in a cohort of US firefighters from San Francisco, Chicago and Philadelphia: an update. Occup Environ Med. 77:84–93. https://doi.org/ 10.1136/oemed-2019-105962 [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Pukkala E, et al. 2014. Cancer incidence among firefighters: 45 years of follow-up in five Nordic countries. Occup Environ Med. 71:398–404. https://doi.org/ 10.1136/oemed-2013-101803 [DOI] [PubMed] [Google Scholar]
  48. Reinhardt TE, Broyles G.. 2019. Factors affecting smoke and crystalline silica exposure among wildland firefighters. J Occup Environ Hyg. 16:151–164. https://doi.org/ 10.1080/15459624.2018.1540873 [DOI] [PubMed] [Google Scholar]
  49. Robinson MS, et al. 2008. Occupational PAH exposures during prescribed pile burns. Ann Occup Hyg. 52:497–508. https://doi.org/ 10.1093/annhyg/men027 [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Rodgers KM, Udesky JO, Rudel RA, Brody JG.. 2018. Environmental chemicals and breast cancer: An updated review of epidemiological literature informed by biological mechanisms. Environ Res. 160:152–182. https://doi.org/ 10.1016/j.envres.2017.08.045 [DOI] [PubMed] [Google Scholar]
  51. Romagnoli E, Barboni T, Santoni P-A, Chiaramonti N.. 2014. Quantification of volatile organic compounds in smoke from prescribed burning and comparison with occupational exposure limits. Nat Hazards Earth Syst Sci. 14:1049–1057. https://doi.org/ 10.5194/nhess-14-1049-2014 [DOI] [Google Scholar]
  52. Santodonato J. 1997. Review of the estrogenic and antiestrogenic activity of polycyclic aromatic hydrocarbons: relationship to carcinogenicity. Chemosphere. 34:835–848. https://doi.org/ 10.1016/s0045-6535(97)00012-x [DOI] [PubMed] [Google Scholar]
  53. Seyyedsalehi MS, et al. 2024. Occupational exposure to benzene and risk of breast cancer: systematic review and meta-analysis. Med Lav. 115:e2024034. https://doi.org/ 10.23749/mdl.v115i5.16306 [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Shah D, et al. 2024. Abstract 835: Occupational-related exposure to benzene and risk of female genital cancers: Systematic review and meta-analysis. Cancer Res. 84:835–835. https://doi.org/ 10.1158/1538-7445.am2024-835 [DOI] [Google Scholar]
  55. USFS. 2024a. The future of fire is female. US Forest Service. Available at https://www.fs.usda.gov/about-agency/features/future-fire-female. Accessed 3 November 2024.
  56. USFS. 2024b. Women in fire: Blazing through barriers. US Forest Service. Available at https://www.fs.usda.gov/about-agency/features/women-fire-blazing-through-barriers. Accessed 3 November 2024.
  57. Viner BJ, et al. 2018. Predicted cumulative dose to firefighters and the offsite public from natural and anthropogenic radionuclides in smoke from wildland fires at the Savannah River Site, South Carolina USA. J Environ Radioact. 182:1–11. https://doi.org/ 10.1016/j.jenvrad.2017.10.017 [DOI] [PubMed] [Google Scholar]
  58. Ward EM, et al. 2019. Carcinogenicity of night shift work. Lancet Oncol. 20:1058–1059. https://doi.org/ 10.1016/s1470-2045(19)30455-3 [DOI] [PubMed] [Google Scholar]
  59. Ward TJ, Spear TM, Hart JF, Webber JS, Elashheb MI.. 2012. Amphibole asbestos in tree bark--a review of findings for this inhalational exposure source in Libby, Montana. J Occup Environ Hyg. 9:387–397. https://doi.org/ 10.1080/15459624.2012.682217 [DOI] [PubMed] [Google Scholar]
  60. Wei W, et al. 2021. Association between long-term ambient air pollution exposure and the risk of breast cancer: a systematic review and meta-analysis. Environ Sci Pollut Res Int. 28:63278–63296. https://doi.org/ 10.1007/s11356-021-14903-5 [DOI] [PubMed] [Google Scholar]
  61. West M, Brown S, Noth E, Domitrovich J, Navarro DuBose K.. 2024. A review of occupational exposures to carcinogens among wildland firefighters. J Occup Environ Hyg. 21:741–764. https://doi.org/ 10.1080/15459624.2024.2388532 [DOI] [PubMed] [Google Scholar]
  62. WFMMC. 2023. ON FIRE: the report of the wildland fire mitigation and management commission. Retrieved January 26, 2024. https://www.usda.gov/sites/default/files/documents/wfmmc-final-report-09-2023.pdf [Google Scholar]
  63. White AJ, et al. 2016. Exposure to multiple sources of polycyclic aromatic hydrocarbons and breast cancer incidence. Environ Int. 89-90:185–192. https://doi.org/ 10.1016/j.envint.2016.02.009 [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. White AJ, et al. 2024. Ambient fine particulate matter and breast cancer incidence in a large prospective US cohort. J Natl Cancer Inst. 116:53–60. https://doi.org/ 10.1093/jnci/djad170 [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. White AJ, Sandler DP.. 2017. Indoor wood-burning stove and fireplace use and breast cancer in a prospective cohort study. Environ Health Perspect. 125:077011. https://doi.org/ 10.1289/EHP827 [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Wolfe MI, et al. 2004. Assessment of urinary metals following exposure to a large vegetative fire, New Mexico, 2000. J Expo Anal Environ Epidemiol. 14:120–128. https://doi.org/ 10.1038/sj.jea.7500299 [DOI] [PubMed] [Google Scholar]

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