1. Epi ˚ brand A register based cohort study of cancer and cardiovascular disease in Danish firefighters Kajsa Petersen: kajpet@cancer.dkkajpet@cancer.dk The Danish Cancer Society Research Center

2. Key information  Jan 2015 – 2017  DCSRC and the Department of Occupational and Environmental Medicine, Bispebjerg  Project manager: Johnni Hansen

3. A register based cohort study… Expose d Unexposed

4. 1. Cohort of firefighters  No complete records - Piece together a puzzle  Staff and membership records - Unions - Falck A/S - Municipal fire departments

5. Requested information  CPR number and name  Time and place of employment  Job title  Special functions  Extent of work: full time / part time / volunteers

6. 2. Reference groups -Working male population -Police -Military Generated by ATP

7. 3. Register linkage

8. Status Cohort of 16.860 firefighters Born 1878-1997 (1959) Earliest employment date: Nov 1 st 1901 2,653 deceased

9. Interpretation Development over time Long latency Complex exposures

10. The smoke diver laboratory : 1930-1980 Smoke samples collected by firefighters on the scene Testing of equipment Measures of different exposures

11. Exhaust gasses from fire trucks Common practice to keep engines running at idle in unventilated garages. In 1937 running the diesel trucks at idle for 5 minutes resulted in an average air concentration of carbon monoxide inside the garage of 3200 ppm. Actual ventilation in this century.

12. Extinguishing agents Carbon tetrachloride - From 1910. - Cancer, liver or kidney damage. - Can form numerous more or less toxic compounds in the presence of heat and water.

13. Phosgene Used as a chemical weapon. Acute as well as chronic damage at very low concentrations. In a Danish fire the level of phosgene was measured to be 1000 ppm after using tetra. Even with the available respiratory protection this concentration would be lethal within minutes.

14. We hope to learn a lot more about both the exposure aspect of firefighting and the possible health outcomes in our study. Knowing both sides of the story will increase the acknowledgement of the individual consequences of working as a firefighter.