Firefighter cancer risks: a systematic review and proposal for a volunteer-specific decontamination model

Abstract Objectives Firefighters face a disproportionately high risk of developing cancer due to occupational exposure to carcinogens, including combustion byproducts, diesel exhaust, and per- and polyfluoroalkyl substances (PFAS) found in firefighting foams and protective gear. This study aimed to systematically review existing literature on cancer risks among firefighters, with particular attention to exposures, prevention strategies, and decontamination practices, and to propose a novel model addressing current gaps. Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peer-reviewed articles, international reports, and high-quality training materials were included. A total of 37 records were included in the final review. Data were synthesized across thematic areas relevant to firefighter cancer risk. Results Five key themes were identified: (1) cancer incidence and mortality, (2) occupational exposure sources, (3) basic prevention practices, (4) gear hygiene, and (5) station decontamination models. The review also identified a critical gap in current decontamination protocols for volunteer firefighters in rural areas, who often respond to emergencies using personal vehicles. To address this, we proposed a novel, volunteer-specific decontamination framework, the Schutte Model, adapting existing best practices to minimize carcinogen transfer during gear transport. Conclusions This study provides both an evidence-based synthesis and a novel intervention model. Findings underscore the urgent need for inclusive, low-cost, and culturally tailored prevention strategies to reduce cancer risks among all firefighters, particularly volunteers operating in under-resourced and decentralized contexts.