Objectives This study aims to investigate mortality and cancer incidence of Australian male volunteer firefighters and of subgroups of firefighters by duration of service, era of first service and the number and type of incidents attended.

Methods Participating fire agencies supplied records of individual volunteer firefighters, including incidents attended. The cohort was linked to the Australian National Death Index and Australian Cancer Database. standardised mortality ratios (SMRs) and standardised incidence ratios (SIRs) for cancer were calculated. Firefighters were grouped into tertiles by duration of service and by number of incidents attended and relative mortality ratios and relative incidence ratios calculated.

Results Compared with the general population, there were significant decreases in overall cancer incidence and in most major cancer categories. Prostate cancer incidence was increased compared with the general population, but this was not related to the number of incidents attended. Kidney cancer was associated with increased attendance at fires, particularly structural fires.

The overall risk of mortality was significantly decreased, and all major causes of death were significantly reduced for volunteer firefighters. There was evidence of an increased mortality from ischaemic heart disease, with increased attendance at fires.

Conclusion Volunteer firefighters have a reduced risk of mortality and cancer incidence compared with the general population, which is likely to be a result of a ‘healthy-volunteer’ effect and, perhaps, lower smoking rates.