Sponsored by Masimo
By Bruce Evans
Cancer is now front and center in the health and safety agenda of the American fire service. Many fire departments are conducting their own firefighter physicals, often above and beyond the NFPA 1582 standard (Standard on Comprehensive Occupational Medical Program for Fire Departments).
Cancer has a cycle to consider, which includes prevention, screening and treatment. Prevention activities are well underway through efforts to decontaminate and change out turnout gear and hood systems after each fire. It’s also important to explore technology for early diagnosis and intervention.
While the science on cancer prevention is difficult to capture and validate, the science behind health screening is thoroughly validated. With that in mind, there is an often underutilized tool that is becoming more economical for use in a comprehensive fire department physical.
Ultrasound or sonography is a cost-effective diagnostic tool that can provide an early alert for cancer and other diseases.
Benefits of ultrasound for detecting inflammation
Ultrasound uses sound waves to identify blood flow, inflammation and solid tumors or structural changes in tissues. It does not have the added risk of radiation typical of CAT scans, X-rays or radio nucleotide studies. Ultrasound is also often much cheaper than other diagnostic scans and can also image joints, including commonly injured joints in firefighters, like shoulders.
Most cancer and heart disease starts with inflammation. Emerging science indicates that ultrasound has the ability to identify inflammation early in blood vessels, long before a plaque forms. Ultrasound is so sensitive that it can identify inflammation early so that a firefighter can make changes in diet or medication to improve health.
Identifying tumors early in firefighters
When it comes to cancer, early tumor detection is critical to long-term survival. Tumors kill by displacing other critical functions or organs, taking over blood vessels and growing a blood supply that can allow them to colonize other parts of the body.
Ultrasound has the ability to find tumors early in their growth, increasing the possibility of surgical removal. Some more advanced ultrasound units can create 3-D imaging.
Ultrasound works well on the kidneys, stomach, uterus, liver, spleen, pancreas, thyroid, testes and ovaries. As more evidence linking cancer in these areas to firefighters and products of combustion is identified, sonography can start adding to the body of knowledge and capturing early incidences before they become a cancer fatality statistic.
Understanding and managing firefighters’ unique health risks
The quality of the results depends to a large extent on the skill of the sonographer or doctor operating the transducer, and it’s critical to educate physicians about the specific risks firefighters face. If you incorporate ultrasound into your department’s health screenings, be sure the participating healthcare providers approach all screenings with a higher level of scrutiny than they would in the general population.
Consider a Florida fire chief’s case, when an ultrasound revealed a small nodule on her thyroid gland. She was told it was most likely benign and left the office. After a month of pondering, she returned and advocated for a biopsy, which ultimately revealed a small cancer, caught early and removed. This near miss was due to an apologetic physician who simply didn’t understand the risk and the prevalence of cancer in the fire service.
An on-site fire service health clinic for mass screening could be beneficial. Consider the advancement of community paramedics or critical care paramedics, and the field use of ultrasound, with newer portable machines that can withstand the rigors of the prehospital setting.
Ultrasound’s widespread use has not proliferated, often due to its limited efficacy in the field verses transport to definitive care. However, the economies of scale by employing an additional use of a device to screen employees, even potentially in the fire station, may make this technology more practical.
