Prostate cancer in firefighting and police work: a systematic review and meta-analysis of epidemiologic studies

Objectives: We conducted a systematic review and meta-analysis to evaluate potential associations between firefighting and police occupations, and prostate cancer incidence and mortality. Methods: Original epidemiological studies published from 1980 to 2017 were identified through PubMed and Web of Science. Studies were included if they contained specific job titles for ever/never firefighting and police work and associated prostate cancer risk estimates with 95% confidence intervals (CI). Study quality was assessed using a 20-point checklist. Prostate cancer meta-risk estimates (mRE) and corresponding 95% CIs were calculated for firefighting and police work separately and by various study characteristics using random effects models. Between-study heterogeneity was evaluated using the I-2 score. Publication bias was assessed using Begg's and Egger's tests. Results: A total of 26 firefighter and 12 police studies were included in the meta-analysis, with quality assessment scores ranging from 7 to 19 points. For firefighter studies, the prostate cancer incidence mRE was 1.17 (95% CI = 1.08-1. 28, I-2 = 72%) and the mortality mRE was 1.12 (95% CI = 0.92-1.36, I-2 = 50%). The mRE for police incidence studies was 1. 14 (95% CI = 1.02-1.28; I-2 = 33%); for mortality studies, the mRE was 1.08 (95% CI = 0.80-1.45; I-2 = 0%). By study design, mREs for both firefighter and police studies were similar to estimates of incidence and mortality. Conclusion: Small excess risks of prostate cancer were observed from firefighter studies with moderate to substantial heterogeneity and a relatively small number of police studies, respectively. There is a need for further studies to examine police occupations and to assess unique and shared exposures in firefighting and police work.