Texas Firefighter Cancer Study
In response to growing evidence of elevated cancer risk among firefighters in Texas, and in recognition of the critical need for improved occupational exposure tracking and early detection, the Texas State Legislature appropriated funds through Senate Bill 1 89th Legislature in May 2025 to UTHealth Houston to establish the Texas Firefighter Cancer Study. This two-year initiative is designed to reduce the burden of firefighter-related cancers through three projects. While each project requires a distinct study protocol due to its methodological scope and data sources, they are unified by a shared scientific framework. The overarching protocol conceptualizes firefighter cancer risk as a multi-project process, beginning with exposure to carcinogens during firefighting activities, progressing through biological alterations, culminating in cancer diagnoses confirmed by registries, and clinical cancer screening promotion campaigns.
The three initial projects include:
Project 1 Carcinogenic Exposure Assessment - Quantitative measurement of occupational exposure to fire-related carcinogens and analysis of exposure-associated molecular biomarkers in new recruits, active-duty firefighters, and retirees;
Project 2 Occupational Cancer Epidemiology - Evaluation of cancer incidence through the linkage of occupational histories, demographic variables, and data from the Texas Cancer Registry;
Project 3 Cancer Screening Promotion - Implementation of a firefighter-specific cancer screening initiative as part of the annual occupational medical examination, incorporating cancer-associated molecular tools for risk stratification and early detection.
Study Team (PI: Jooyeon Hwang):
Stakeholders Advisory Board
• Fire Associations including
o HPFFA, Houston Professional Fire Fighters' Association
o SFFMA, State Firefighters' and Fire Marshals' Association of Texas
o TSAFF, Texas State Association of Firefighters
o TFCA, Texas Fire Chiefs Association
o TCFP, Texas Commission on Fire Protection
o SFMO, State Fire Marshal's Office
o IAFF, International Association of Fire Fighters
o Retired Firefighters Association
• Fire Departments including
o Houston
o Austin
o Brownsville
o Dallas/Ft. Worth
o El Paso
o San Antonio
Scientific Advisory Board
Gurumurthy Ramachandran, PhD
Professor, Johns Hopkins Bloomberg School of Public Health Environmental Health and Engineering
Director, Johns Hopkins Education and Research Center for Occupational Safety and Health
Drew Helmer, MD
Professor, Baylor College of Medicine, Health Services Research
Deputy Director, Michael E. DeBakey VA Medical Center, Center for Innovations in Quality, Effectiveness & Safety
Shine Chang, PhD
Professor, MD Anderson Cancer Center, Health Disparities Research, Division of Cancer Prevention and Population Sciences
Director, Cancer Prevention and Population Sciences, Cancer Prevention Research Training Program,
Caitlin Murphy, PhD
Professor, University of Chicago, Pediatrics-Hematology, Oncology and Epidemiology
• Texas State Legislators
• Governmental Relations
• Media Relations
Carcinogenic Exposure Assessment
Xinyi Niu, PhD
[email protected]
Amelia Chen, PhD
[email protected]
Occupational Cancer Epidemiology
Abolore Muinat Idris, PhD
[email protected]
Cancer Screening Promotion
Study Operations
Masoud Afshar
[email protected]
Rocio Rodriguez
[email protected]
Paulina Romero
[email protected]
Chao Xu, PhD
[email protected]
Paul Grunsted
[email protected]
Juan Alvarez
[email protected]
Jingyu Liang
[email protected]
Quanjiang Li
[email protected]
Kevin Dang
[email protected]
SWCOEH: Admin Support
Sarah Felknor, PhD
[email protected]
Annette Allett
[email protected]
Lacy Davis, MA
[email protected]
Rebecca Klaff
[email protected]
Leah Merrill
[email protected]
Silvia Santiago
[email protected]
Josie Chevis
[email protected]
Human Genetic Center: Biospecimen Processing
Megan Grove
[email protected]
Claudette Huitt
[email protected]
Malini Udtha
[email protected]
Susan Rossi
[email protected]
Irina Roller
[email protected]
Trung Nguyen
[email protected]
Donald Mathews
[email protected]
Abena Agyei
[email protected]
Coordinating Center for Clinical Trials: Data Integrity Support
Dejian Lai, PhD
[email protected]
Kiran Mansoor
[email protected]
Alphonsa Kochupurackal Devasia
[email protected]
PUBLICATIONS
Multi-omics studies
- Jooyeon Hwang*, Jenny Gipson, Chao Xu, Timothy VanWagoner, Xin Xu, Robert J. Agnew, Willard M. Freeman Comparison of MicroRNA Profiling in the Skin and Serum of Volunteer and Career Firefighters, Environmental Research, 2025, Volume 285, Part 1, 122348, DOI: https://doi.org/10.1016/j.envres.2025.122348
- Jooyeon Hwang*, Zongkai Peng, Fares Z Najar, Chao Xu, Robert J Agnew, Xin Xu, Zhibo Yang, Nagib Ahsan*, Urine proteome profile of firefighters with exposure to emergency fire-induced smoke: A pilot study to identify potential carcinogenic effects, Science of the Total Environment, 2024, 972, 172273, DOI: https://doi.org/10.1016/j.scitotenv.2024.172273
- Ting Zhu, Yuxiang Hu, Jooyeon Hwang, Dan Zhao, Libin Huang, Liang Qiao, Ankui Wei, Xin Xu. Urinary Proteomics of Simulated Firefighting Tasks and its Relation to Fitness Parameters, Int. J. Environ. Res. Public Health, 2021, Oct 11;18(20), 10618, PMID: 34682364 PMCID: PMC8536002. DOI: https://doi.org/10.3390/ijerph182010618
Carcinogens
- Mingze Zhu+, Jooyeon Hwang*, Chao Xu*. Meta-analysis identifies key genes and pathways implicated in Benzo[a]pyrene exposure response, Chemosphere, 2024, Volume 364, September 2024, 143121, https://doi.org/10.1016/j.chemosphere.2024.143121
- Mingze Zhu+, Robert J. Agnew, Chao Xu, Timothy VanWagoner, Xin Xu, Jooyeon Hwang*. Residual Polycyclic Aromatic Hydrocarbons and Firefighters’ Hematological Profile, Frontiers in Environmental Health, Sec. Occupational Safety and Health Interventions, 2024, Volume 3 – 2024, https://doi.org/10.3389/fenvh.2024.1381159
- Jooyeon Hwang, Chao Xu, Paul Grunsted, Robert J. Agnew, Tara R. Malone, Shari Clifton, Krista Thompson, Xin Xu. Urinary Metabolites of Polycyclic Aromatic Hydrocarbon in Firefighters: A Systematic Review and Meta-Analysis, Int. J. Environ. Res. Public Health, 2022, 19(14):8475, PMID: 35886320 PMCID: PMC9318785 DOI: https://doi.org/10.3390/ijerph19148475
Exposure Assessment
- Jooyeon Hwang, Chao Xu, Robert J. Agnew, Shari Clifton, Tara R. Malone. Health Risk of Structural Firefighters from Exposure to Polycyclic Aromatic Hydrocarbons: A Systematic Review and Meta-Analysis, International Journal of Environmental Research and Public Health, 2021, 18(8), 4209, PMID: 33921138, PMCID: PMC8071552 DOI: https://doi.org/10.3390/ijerph18084209
- Jooyeon Hwang, Ritchie Taylor, Charles Cann, Vijay Golla, Weylin Gilbert. Assessment of ambient air diesel particulates in fire departments using different exposure metrics: Pilot study, Fire Safety Journal, 2019, 106: 155-162, DOI: https://doi.org/10.1016/j.firesaf.2019.04.005
- Jooyeon Hwang, Ritchie Taylor, Charles Cann, Pauline Norris, Vijay Golla. Evaluation of accumulated polycyclic aromatic hydrocarbons and asbestiform fibers on firefighter vehicles: Pilot Study, Fire Technology, 2019, 55(6): 2195-2213, https://doi.org/10.1007/s10694-019-00851-7
Turnout Gear
- Jake Mitchell, Jooyeon Hwang, Preston Larson, Sumit Mandal, Robert J. Agnew. Preliminary analyses of accumulation of carcinogenic contaminants on retired firefighter ensembles, Journal of Occupational and Environmental Hygiene, 2024, 21:4, 213-219 PMID: 38416517 DOI: https://doi.org/10.1080/15459624.2023.2296628
- Gretchen Macy, Jooyeon Hwang, Ritchie Taylor, Vijay Golla, Charles Cann, Brittney Gates, Examining Behaviors Related to Retirement, Cleaning, and Storage of Turnout Gear Among Rural Firefighters, Workplace Health and Safety, 2019, 68 (3):129-138, PMID: 31735131 DOI: https://doi.org/10.1177/2165079919882951
- Jooyeon Hwang, Ritchie Taylor, Gretchen Macy, Charles Cann, Vijay Golla. Comparison of Use, Storage, and Cleaning Practices for Personal Protective Equipment Between Career and Volunteer Firefighters in Northwestern Kentucky in the U.S, Journal of Environmental Health, 2019, 82(5), 8-15 DOI: https://www.jstor.org/stable/26858040
Fire Service Communities
- Jooyeon Hwang, Ngee-Sing Chong, Mengliang Zhang, Robert J. Agnew, Chao Xu, Zhuangjie Li, Xin Xu. Face-to-face with Scorching Wildfire: Potential Toxicant Exposure and the Health Risks of Smoke for Wildland Firefighters at the Wildland-Urban Interface, Lancet Reg Health Am. 2023 Mar 26;21:100482. PMID: 37008196 PMCID: PMC10060103 DOI: https://doi.org/10.1016/j.lana.2023.100482
- Ritchie Taylor, Gretchen Macy, Jooyeon Hwang, Vijay Golla, Charles Cann, Edrisa Sanyang, Using Collaborative Partnerships to Engage Firefighters in Rural Communities. Int. J. Environ. Res. Public Health, 2022, 19(4):2009. PMID: 35206197 PMCID: PMC8871703 DOI: https://doi.org/10.3390/ijerph19042009
PRESENTATIONS

Occupational Risk Factors for Mental Health Outcomes in Firefighters, GET PHIT Summit, Laredo, TX (Poster presenter: Kevin Dang)

Effectiveness of Dermal Wipes in Removing PAHs From Urban Firefighters, UTHealth-CPRIT 2025 Summer Undergraduate Innovation in Cancer Prevention Research Program, Houston, TX (Poster presenter: Isabella Smetana)

The role of decontamination wipes on polycyclic aromatic hydrocarbons (PAHs) removal and microbiome shifts in firefighter skin, AIHA Connect 2025 Student poster, Kansas City, MO (Poster presenter: Catherine Turlington)

Fire Smoke Neurotoxicants: Occupational Exposure and Mental Health Implications for Firefighters, 2025 International Fire Service Cancer Symposium, Firefighter Cancer Initiative, Miami, FL (Poster presenter: Jooyeon Hwang)

Impact of Exposure to Fire Smoke on miRNA Expression in Firefighters' Blood and Skin Samples, American Society of Human Genetics 2024 Annual Meeting, Denver, Colorado (Poster presenter: Paul Grunsted)
Multi-Omics Profiling for Evaluating Carcinogenic Exposure and Health Effects in Firefighters During Emergency Fires, 36th annual US-Korea Conference (UKC 2023), Technical Group Symposium, Medical Science, Pharmaceutical Science, Veterinary Medicine, Physical Education (MPS), Dallas, Texas (Invited speaker: Jooyeon Hwang)
Nasal Cavity Microbial Makeup and the Influence on Psychiatric Symptoms Following Acute Fire Exposure in Firefighters, American Society of Human Genetics, Boston, MA (Poster presenter: Paul Grunsted)
Industrial Hygiene and Exposure Science Laboratory (PD: Jooyeon Hwang, PhD, CIH)
A. Chemical Characterization of Environmental Samples
Major Equipment:
• Agilent Gas Chromatograph/Mass Spectrometry Triple Quadrupole (GC-MS/MS) 8890 GC/7010D Triple Quadrupole
• Agilent Gas Chromatograph/Mass Spectrometry (GC/MS) 6890 GC/ 5973 MS
• Agilent Gas Chromatograph/Mass Spectrometry (GC/MS) 6890 GC/ 5975B MS
• Agilent Gas Chromatograph/Mass Spectrometry (GC/MS) 8890 GC/ 5977B MS
• Agilent Inductively Coupled Plasma Mass Spectrometry (ICP-MS) 7500CX
Gas Chromatography–Mass Spectrometry (GC/MS) is a powerful analytical technique that combines two methods to separate and identify in a sample. First, Gas Chromatography (GC) separates volatile compounds by carrying them through a heated column, allowing different chemicals to elute at different times. Then, the separated compounds enter the Mass Spectrometer (MS), where they are fragmented and analyzed based on their mass-to-charge ratios to identify the original molecules. This technique is widely used in fields such as environmental and occupational monitoring, forensics, and pharmaceutical research to detect and quantify chemicals in complex mixtures. At present, the UTHealth Houston School of Public Health, Industrial Hygiene and Exposure Science Laboratory has four GC/MS systems, including one GC-MS/MS triple quadrupole, which is a significantly more powerful instrument compared to a single quadrupole GC/MS also ICP-MS instrument for the analysis and detection of trace metals in various media.
Comprehensive list of the main organic compound groups that can be analyzed by Gas Chromatography-Mass Spectrometry (GC/MS). Along with examples of typical compounds in each group and where they are commonly found:
1. Alkanes (Saturated Hydrocarbons)
Characteristics: Nonpolar, very volatile, Examples:
• Methane (CH4)
• Octane (C8Ha8)
• Decane (C10H22)
Application: Petroleum products, fuels, lubricants.
2. Alkenes and Alkynes (Unsaturated Hydrocarbons)
Characteristics: Volatile, reactive compounds with double/triple bonds. Examples:
• Ethylene (C2H4)
• Propene (C3H6)
• 1-Butyne (C4H6)
Applications: Industrial emissions, fuel combustion studies.
3. Volatile Organic Compound
Characteristics: Ring compounds, often stable and volatile. Examples:
• 1-1,3-Butadien
• 2-n-Pentane
• Isoprene
• Methylen Chloride
• Methyl tetra-Butyl ethylene
• 6-n-Hexane
• Chloroprene
• Methylcyclopentane
• Methyl Ethyl Ketone (2 butanone)
• Chloroform
• 11-2,3-Dimethylpentane
• Carbone tetrachloride
• Benzene
• Trichloroethylene
• Toluene
• Tetrachloroethylene
• Ethylbenzene
• 18-n-Nonane
• m&p-Xylene
• 20-o-Xylene
• Styrene
• alpha-pinene
• nDecane
• 24-1,3,5-Trimethylbenzene
• 25-1-ethyl-2-methylbenzene
• bete-pinene
• 27-1,2,4-trimethylbenzene
• 28-D-Limonene
• 29-1,2,3-trimethylbenzene
• 30-1,4-Dichlorobenzene
• Naphthalene
Applications: Air pollution, gasoline analysis, industrial solvents:
4. Polycyclic Aromatic Hydrocarbons (PAHs)
Characteristics: Multi-ring compounds, semi-volatile. Examples:
• Naphthalen
• 2-1-methyl-Naphthalene
• Acenaphthylene
• Acenaphthene
• Florene
• Phenanthrene
• Antheracene
• Fluranthene
• Pyrene
• Benzo[a]anthracene
• Chrysene
• Benzo[a] pyrene
• benzo[k] fluoranthene
• Benzo[b] fluoranthene
• dibenz [a, h] anthracene
• Indeno [1,2,3, -cd] pyrene
• Benzo[ghi] perylene
Application: Environmental monitoring (air, soil, water), combustion by-products.
5. Alcohols
Characteristics: Can be analyzed directly (small ones) or after derivatization (large or polar ones) Examples:
• Methanol
• Ethanol
• Isopropanol
• Butanol
Applications: Forensic testing, beverages, fuels.
6. Aldehydes and Ketones
Characteristics: Volatile carbonyl compounds, often derivatized for better stability. Examples:
• Acetones
• Butanone (MEK)
• Benzaldehyde
Applications: Indoor air analysis, Industrial solvents.
7. Carboxylic Acid and Esters
Characteristics: Often need derivatization to form volatile methyl ester. Examples:
• Acetic acid → methyl acetate
• Butyric acid → methyl butyrate
• Ethyl acetate
• Isoamyl acetate (banana scent)
Applications: Flavor/fragrance analysis, food chemistry, biodiesel.
8. Ethers
Examples:
• Diethyl ether
• Methyl tert-butyl ether (MTBE)
• Tetrahydrofuran (THF)
Applications: Solvent residue analysis, fuel oxygenates.
9. Amines
Characteristics: Basic nitrogen compounds, may need degravitation. Examples:
• Methylamine
• Dimethylamine
• Aniline
Applications: Environmental and pharmaceutical analysis.
10. Nitriles
Examples:
• Acetonitrile
• Propionitrile
• Benzonitrile
Applications: Industrial chemical monitoring.
11. Halogenated Hydrocarbons:
Characteristics: Volatile and stable. Examples:
• Chloroform
• Carbon tetrachloride
• Dichloromethane (methylene chloride)
• Trichloroethylene
Application: Solvent screening, groundwater contamination.
12. Pesticides (Volatile and Semi-Volatile Types)
Examples:
• Lindane
• DDT
• Aldrin
• Malathion
• Chlorpyrifos
Applications: Environmental, food residue testing.
13. Phthalates (Plasticizers)
Examples:
• Diethyl phthalate (DEP)
• Di-n-butyl phthalate (DBP)
• Di(2-ethylhexyl) phthalate (DEHP)
Applications: Plastic contamination, consumer products.
14. Phenols
Examples:
• Phenol
• Cresol
• Nonylphenol
Applications: Industrial wastewater, environmental monitoring.
15. Polychlorinated Biphenyls (PCBs)
Examples:
• PCB-28
• PCB-52
• PCB-180
Applications: Environmental pollutant analysis (soil, sediments)
16. Drugs and Metabolites (Volatile or Derivatized)
Examples:
• Amphetamine
• Methamphetamine
• Steroids (after derivatization)
Applications: Forensic toxicology, clinical testing.
17. Other Semi-Volatile Organics (SVOCs)
Examples:
• Dioxins
• Furans
• PAH
Applications: Environmental and hazardous waste analysis
Inductively Coupled Plasma Mass Spectrometry (ICP-MS) is a highly sensitive analytical technique used to determine the elemental and isotopic composition of a sample. The sample is ionized in a high-temperature argon plasma, and the resulting ions are separated by their mass-to-charge ratios in a mass spectrometer. This method enables the detection of most elements at ultra-trace concentrations, making it essential for applications such as environmental and occupational monitoring, geochemistry, pharmaceuticals, and clinical research.
Developed and implemented an Inductively Coupled Plasma Mass Spectrometry (ICP-MS) method for analyzing various media, including water, soil, blood, and urine, to determine 30 metals, including toxic heavy metals in Parts per billion (ppb) level. Our laboratory analyzes a wide range of metals—below are selected examples.
• Beryllium (Be)
• Sodium (Na)
• Magnesium (Mg)
• Aluminum (Al)
• Potassium (K)
• Calcium (Ca)
• Scandium (Sc)
• Vanadium (V)
• Chromium (Cr)
• Manganese (Mn)
• Iron (Fe)
• Cobalt (Co)
• Nickel (Ni)
• Copper (Cu)
• Zinc (Zn)
• Arsenic (As)
• Selenium (Se)
• Strontium (Sr)
• Rhodium (Rh)
• Silver (Ag)
• Cadmium (Cd)
• Antimony (Sb)
• Barium (Ba)
• Terbium (Tb)
• Titanium (TI)
• Lead (Pb)
• Bismuth (Bi)
• Thorium (Th)
• Uranium (U)
B. Advanced Aerosol Exposure Assessment
Air sampling equipment and numerous state-of-art direct-reading air instruments are available for comprehensive exposure assessment:
• Aerodynamic Particle Sizer
• Scanning Mobility Particle Sizer
• Condensation Particle Counter
• Micro-Orifice Uniform Deposition Cascade Impactor
• Indoor Air Quality Monitors
• Light-scattering Laser Photometer
• Real-time Aerosol Monitors
• Nanoparticle Sizer
• Personal Air Pumps
• Air Flow meters
C. Aerosol Generation Experiments
Our laboratory experimental setup for aerosol assessment includes the following equipment:
• Atomizer Aerosol Generator
• Six-Jet Atomizer
• Single Jet Atomizer
• Impactor Inlet
• Small Scale Powder Disperser
• Aerosol Spectrometers
• Charger Neutralizer
• Fluorometers
UTHealth Houston launches firefighter cancer risk study with kick-off event

UTHealth Houston School of Public Health and Southwest Center for Occupational and Environmental Health hosted a kickoff event to celebrate the launch of a $5 million, multi-year initiative focused on reducing cancer risks and health impacts of environmental exposures for firefighters.
UTHealth Houston study links firefighter smoke exposure to biological changes that increase cancer risk

A new study published in Environmental Research by researchers at UTHealth Houston offers valuable insights into how firefighting can affect the body on a molecular level, potentially leading to long-term health risks such as cancer.
Researchers with UTHealth Houston School of Public Health awarded $5 million to study cancer risk among firefighters in Texas

The state of Texas awarded UTHealth Houston School of Public Health $5 million over two years for early detection and research, led by principal investigator Jooyeon Hwang, PhD, associate professor in the Department of Environmental and Occupational Health Sciences, on cancer risk among firefighters in Texas.