Individual and Occupational Factors Associated with Receipt of Guideline-Concordant Cancer Screening in California Firefighters

Abstract Background: Firefighters face elevated cancer risk due to occupational exposures, yet cancer screening adherence and associated factors remain poorly characterized. Methods: We conducted a cross-sectional analysis of survey data from 3,076 active-duty career firefighters in California without a prior cancer diagnosis. Screening adherence was evaluated against U.S. Preventive Services Task Force (USPSTF) and National Fire Protection Association (NFPA) guidelines for colorectal (CRC), breast, cervical, prostate, skin, and lung cancer. Multivariable logistic regression was used to assess the associations between screening receipt and demographic, occupational, behavioral, clinical, and health belief factors. Results: Overall, screen-eligible participants were racially/ethnically diverse (25% Hispanic; 37% non-White), had a mean age of 41 years, and a mean tenure in the fire service of 17 years. Receipt of guideline-concordant screening varied by cancer type and guideline: CRC (54% NFPA, 68% USPSTF), breast (76%), cervical (75%), prostate (59% NFPA, 78% USPSTF), skin (29%), and lung (ever low-dose computed tomography, 10%). Older age (odds ratio [OR]=1.19-2.65 per 5 years), 1+ years since a routine doctor’s visit (OR=0.36-0.58), and family history of cancer (OR=1.33-1.77) were consistently associated with receipt of cancer screening. Conclusions: Firefighters who were younger (yet within eligibility age range), had not recently engaged in routine healthcare, and did not have a family history of cancer were less likely to be screened. Impact: This is the first broad characterization of cancer screening among career firefighters, identifying potentially actionable targets for interventions to close screening gaps in this high-risk population.