Objectives To investigate mortality and cancer incidence of paid male Australian firefighters and of subgroups of firefighters by era of first employment, duration of employment and number and type of incidents attended.

Methods Participating fire agencies supplied records of individual firefighters including their job histories and incidents attended. The cohort was linked to the Australian National Death Index and Australian Cancer Database. SMRs and SIRs were calculated. Firefighters were grouped into tertiles by duration of employment and by number of incidents attended and relative mortality ratios and relative incidence ratios calculated. Analyses were carried out separately for full-time and part-time male firefighters.

Results Compared to the Australian population, there were significant increases in overall risk of cancer, for all paid firefighters SIR 1.09 (95% CI 1.03 to 1.14), in prostate cancer, full-time firefighters 1.23 (95% CI 1.10 to 1.37), part-time 1.51 (1.28 to 1.77), and melanoma full-time 1.45 (95% CI 1.26 to 1.66), part-time firefighters 1.43 (95% CI 1.15 to 1.76). Kidney cancer was associated with longer service in internal analyses for paid firefighters. Prostate cancer was associated with longer service and increased attendance at fires, particularly structural fires for full-time firefighters.The overall risk of mortality was significantly decreased and almost all major causes of death were significantly reduced for paid firefighters.

Conclusions Male paid firefighters have an increased risk of cancer. They have reduced mortality compared with the general population, which is likely to be a result of a strong healthy worker effect and likely lower smoking rates among firefighters compared with the Australian population.