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      Contaminación de los equipos de trabajo y riesgo de cáncer de próstata y testículo, en bomberos Translated title: Personal protective equipment's contamination and risk of prostate and testes cancer, in firefighters

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          Abstract

          Antecedentes: Los bomberos, en el ejercicio de su actividad laboral, están expuestos en forma aguda y crónica a sustancias peligrosas que conllevan un riesgo para la salud; dichas sustancias (varias de ellas clasificadas como cancerígenas) están presentes en el escenario de extinción del fuego y fuera de éste. Los equipos de protección personal han ido evolucionado con el fin de minimizar los daños. En este artículo revisamos la evidencia existente en cuanto a contaminación a través de equipos de trabajo y si la profesión de bombero supone un riesgo para el desarrollo de cáncer de testículo y próstata. Objetivos: Conocer la implicación de los equipos de trabajo como fuente adicional de contaminación en bomberos. Ver la asociación de esta profesión con cáncer de testículo y próstata. Métodos: Búsqueda bibliográfica en Pubmed, Toxnet, Scopus y OSH Update, Google scholar y webs institucionales; recopilamos 20 artículos (11 de exposición y 9 relacionados con cáncer testicular y próstata). Resultados: Se encontraron hidrocarburos aromáticos policíclicos (HAP), compuestos orgánicos volátiles (COV), algunos cancerígenos, que se adhieren a los EP. Los cánceres testicular y prostático tuvieron asociación estadísticamente significativa en 4 y 5 estudios, que valoraban incidencia y mortalidad, respectivamente; dentro de los que se incluye un metaanálisis. Conclusiones: Parece existir contaminación, a través de los equipos de protección, bien por sustancias liberadas en forma de gas, transferencia cutánea y/o desarrollo de un microambiente tóxico entre el traje y la piel. Se encontró asociación estadística significativa para cáncer de próstata y testículo.

          Translated abstract

          Background: Firefighters, in the exercise of their work, are exposed to acute and chronically hazardous substances that pose a health risk; these substances (some classified as carcinogenic) are present in the scene extinguishing the fire and out of this. Personal protective equipment (PPE), have evolved in order to minimize damage. In this paper, we review the actual evidence about contamination through EP and if firefighters are in risk about prostate and testis cancer. Objectives: To know the involvement of PPE as an additional source of pollution in fire. To see the association with testicular cancer and prostate cancer. Methods: Research in PubMed, Toxnet, Scopus and OSH Update, Google scholar and institutional websites; we collect 20 articles (11 and 9 related to exposure testicular cancer and prostate). Results: Polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs), some carcinogens, adhering to the EP. Testicular and prostate cancer had a statistically significant association in studies 4 and 5 respectively that assessed incidence and mortality; this included a meta-analysis. Conclusions: It seems that there's contamination through PPE, as some substances released as a gas, by dermal contamination or by creation of toxic microenvironment between suit and skin. Different substances released during or after the fire stick to the EP, creating a "toxic microenvironment" between the suit and the skin, promoting systemic absorption. We found statistically significant association to prostate and testicular cancer.

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          Most cited references39

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          Cancer risk among firefighters: a review and meta-analysis of 32 studies.

          The objective of this study was to review 32 studies on firefighters and to quantitatively and qualitatively determine the cancer risk using a meta-analysis. A comprehensive search of computerized databases and bibliographies from identified articles was performed. Three criteria used to assess the probable, possible, or unlikely risk for 21 cancers included pattern of meta-relative risks, study type, and heterogeneity testing. The findings indicated that firefighters had a probable cancer risk for multiple myeloma with a summary risk estimate (SRE) of 1.53 and 95% confidence interval (CI) of 1.21-1.94, non-Hodgkin lymphoma (SRE = 1.51, 95% CI = 1.31-1.73), and prostate (SRE = 1.28; 95% CI = 1.15-1.43). Testicular cancer was upgraded to probable because it had the highest summary risk estimate (SRE = 2.02; 95% CI = 1.30-3.13). Eight additional cancers were listed as having a "possible" association with firefighting. Our results confirm previous findings of an elevated metarelative risk for multiple myeloma among firefighters. In addition, a probable association with non-Hodgkin lymphoma, prostate, and testicular cancer was demonstrated.
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            Epidemiology of prostate cancer.

            Prostate cancer incidence and mortality rates vary worldwide. In the United States, prostate cancer is the most common malignancy affecting men and is the second-leading cause of cancer death. Risk of developing prostate cancer is associated with advancing age, African American ethnicity, and a positive family history, and may be influenced by diet and other factors. The incidence of prostate cancer increased sharply after the introduction of widespread screening for prostate-specific antigen (PSA), although rates have now returned to levels seen before that time. PSA screening has been associated with a shift toward diagnosis of earlier-stage disease, but this has not been accompanied by a shift toward a lower histologic grade. Although overall prostate cancer mortality rates decreased during the 1990s, it was largely because of reductions in deaths among men diagnosed with distant disease. In contrast, mortality rates for men diagnosed with localized or regional disease increased gradually during most of the 1990s before decreasing slightly among white men and reaching plateaus among African Americans.
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              Systemic Exposure to PAHs and Benzene in Firefighters Suppressing Controlled Structure Fires

              Turnout gear provides protection against dermal exposure to contaminants during firefighting; however, the level of protection is unknown. We explored the dermal contribution to the systemic dose of polycyclic aromatic hydrocarbons (PAHs) and other aromatic hydrocarbons in firefighters during suppression and overhaul of controlled structure burns. The study was organized into two rounds, three controlled burns per round, and five firefighters per burn. The firefighters wore new or laundered turnout gear tested before each burn to ensure lack of PAH contamination. To ensure that any increase in systemic PAH levels after the burn was the result of dermal rather than inhalation exposure, the firefighters did not remove their self-contained breathing apparatus until overhaul was completed and they were >30 m upwind from the burn structure. Specimens were collected before and at intervals after the burn for biomarker analysis. Urine was analyzed for phenanthrene equivalents using enzyme-linked immunosorbent assay and a benzene metabolite (s-phenylmercapturic acid) using liquid chromatography/tandem mass spectrometry; both were adjusted by creatinine. Exhaled breath collected on thermal desorption tubes was analyzed for PAHs and other aromatic hydrocarbons using gas chromatography/mass spectrometry. We collected personal air samples during the burn and skin wipe samples (corn oil medium) on several body sites before and after the burn. The air and wipe samples were analyzed for PAHs using a liquid chromatography with photodiode array detection. We explored possible changes in external exposures or biomarkers over time and the relationships between these variables using non-parametric sign tests and Spearman tests, respectively. We found significantly elevated (P < 0.05) post-exposure breath concentrations of benzene compared with pre-exposure concentrations for both rounds. We also found significantly elevated post-exposure levels of PAHs on the neck compared with pre-exposure levels for round 1. We found statistically significant positive correlations between external exposures (i.e. personal air concentrations of PAHs) and biomarkers (i.e. change in urinary PAH metabolite levels in round 1 and change in breath concentrations of benzene in round 2). The results suggest that firefighters wearing full protective ensembles absorbed combustion products into their bodies. The PAHs most likely entered firefighters’ bodies through their skin, with the neck being the primary site of exposure and absorption due to the lower level of dermal protection afforded by hoods. Aromatic hydrocarbons could have been absorbed dermally during firefighting or inhaled during the doffing of gear that was off-gassing contaminants.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                mesetra
                Medicina y Seguridad del Trabajo
                Med. segur. trab.
                Escuela Nacional de Medicina del Trabajo. Instituto de Salud Carlos III (Madrid, Madrid, Spain )
                0465-546X
                1989-7790
                September 2016
                : 62
                : 244
                : 241-262
                Affiliations
                [02] Madrid orgnamela Comunidad de Madrid orgdiv1Área 11 orgdiv2Unidad Docente de Medicina del Trabajo España
                [01] orgnameUnidad Docente de Medicina de Trabajo de Asturias España
                [03] Madrid orgnameInstituto de Salud Carlos III orgdiv1Escuela Nacional de Medicina del Trabajo España
                Article
                S0465-546X2016000300007
                2356c67d-7c41-45f8-8bc5-af926b71bbf6

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 15 August 2016
                : 21 July 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 31, Pages: 22
                Product

                SciELO Spain


                Firefighters,testicular neoplasms,prostatic neoplasms,protective clothing,occupational exposure,exposición profesional,Bomberos,neoplasias testiculares,neoplasias prostáticas,ropa de protección

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