I never saw that coming — Cancer in the fire service

“I never saw that coming” is something we hear all too often in the fire service. Firefighters of all ages are being diagnosed with cancer at alarming rates. Studies show that firefighters have a greater chance than the general population of getting six types of cancer:

• intestinal, liver, prostate, and non-Hodgkin’s lymphoma – 1 to 1
• testicular – 2.2 to 1
• malignant melanoma – 2.5 to 1
• skin, bladder, and leukemia – 3 to 1
• brain – 3.5 to 1
• kidney – 4 to 1

The situation has become so dire that 33 states and 9 Canadian provinces made cancer a presumptive job-related injury. There’s currently no single source collecting data on firefighter cancer, which means there are no hard numbers on its prevalence in the fire service. Last year, I became one of those who said “I never saw that coming.” Here is my story—and some lessons for us all.

For 35 years, I had the time of my life working in a career that was challenging, rewarding, and fulfilling every day. I never expected to become a member of the association of firefighters with cancer. My career had me work in Fort Lauderdale from 1979 to 1997, just a few years after the infamous Everglades Fertilizer fire, which 50 firefighters fought for days. That was before breathing apparatus was common. During the end of my time in Fort Lauderdale, many of those firefighters were diagnosed with different types of cancer. As I continued my career as a fire chief in two other cities, I kept hearing about my former coworkers getting sick. Some recovered, but too many died. That never left the back of my mind, and it had a profound effect on my actions as a chief. And last year, when I started having pain in my right side near my kidney, that memory made me go directly to my doctor.

My doctor researched potential ailments, such as a muscle pull or kidney stones. He ordered x-rays, but they didn’t show any issues. Still the pain continued. His office then made a recommendation that I think saved my life: Go to the emergency room because “they won’t let you go until they find the problem.”

The next morning I did just that. The emergency room doctors ran a CAT scan, didn’t like the results, and conducted an ultrasound. That confirmed what they had thought, and they told me to see a urologist “right away.” That was my first indication that I might be a member of the infamous cancer association. The urologist was not familiar with the latest reports of firefighters and cancer. I gave him my history and that of many friends. He took a very aggressive approach even while telling me he didn’t think it was cancer.

Within weeks, I had oblation surgery, where a biopsy was conducted, and we got the results. We really didn’t need to hear them, though, as my surgeon had already told my wife and me that he “killed it. I really killed all of it.” That pretty much said “cancer” to us. The biopsy confirmed a right, lower-pole renal lesion characterized as a malignant Bosniak III Stage 1 lesion. How did this happen to me? What did I do during my firefighting time that may have contributed to getting cancer?

I did pretty much what everyone did. We always took off our breathing apparatus (SCBA) right after the bulk of the fire was put out but while still in the smoke. We almost never showered directly after the fire, and there were nights we went from one fire to another and another. We dumped our bunker pants by our bed and just crashed. We rarely cleaned our gear. I remember days that I went home and took a shower the next night still smelling the smoke emitting from my pores—15 hours after the fires I had fought.

The real eye-opener for me was taking supplies out of a storage room inside the living quarters of the station and seeing a ring of diesel soot around the bottle. The exhaust from the apparatus permeated the station and consequently our bodies. All of the actions I mentioned have proved to contribute to the risk of getting cancer. That’s why the Firefighters Cancer Support Network and every fire-related organization recommend these actions:

1. Always wear PPE and SCBA on all fires, including during overhaul.
2. Before leaving the fire scene, perform a gross decontamination to remove potentially toxic contaminates from your turnouts and gear.
3. Rinse and wipe off hands, arms, face, neck, etc., immediately after the fire.
4. After the fire, bag your gear to avoid unnecessarily inhaling off-gassing carcinogens.
5. Always use the vehicle exhaust capture system to minimize exhaust fumes in the engine bay and living quarters.
6. If available, a clean second set of turnouts should be used upon returning to the station, and the contaminated turnouts should be thoroughly cleaned. If a second set of turnouts is not available and/or thoroughly cleaning turnouts is not an immediate option, take care to clean off as much of the contaminates as possible.
7. Turnouts should be hung in a well-ventilated area away from crew or apparatus passenger compartments until proper cleaning is possible.
8. After returning to the station and outfitting your equipment, crew members should thoroughly shower to remove carcinogens from skin and hair and then change into clean clothes.
9. Immediately clean contaminated clothing and gear at the station.
10. Don’t throw your contaminated clothing on your bed or in your locker, where it will contaminate your bedding or other clothing, and don’t off-gas in the crew quarters.
11. Don’t take contaminated materials, clothing, or gear home, where you will further expose yourself and your family to carcinogens from the fire.
12. Don’t wear or bring turnouts (dirty or clean) into living or sleeping areas.
13. Document your exposures in either a PERS (Personal Exposure Reporting System) or personal binder. At minimum, keep track of the date, time, run ID number, the crew that was present, exposure or materials burning, and duration of exposure.

When I was chief in Manchester, Connecticut, and Port Orange, Florida, I was able to provide firefighters with two sets of gear and washer/extractors. At the time, I didn’t realize the true value of having clean gear to use after a fire. I knew it was a good practice but didn’t realize how important it was. Now we’ve discovered that we need to change what we did in the past to save future generations of firefighters and their families from dealing with cancer.

Experience is an opportunity to learn and pass on lessons to others. My takeaway from my experience is that firefighting means working in an environment of unknown hazards that can have devastating long-term effects on our safety and health. Firefighters must take every precaution to reduce those risks.

I’m one of the lucky ones; I listened to my body. I knew something was wrong, and I acted as my own patient advocate, pushing hard to find out the truth. That allowed the doctors to find my cancer early and control it. During my last checkup, my urologist said to my wife and me that I was one of his anomalies: a kidney cancer survivor. He hasn’t had many because the disease is usually found too late. As chiefs, we know we must enforce safe practices, make sure firefighters understand why dirty gear needs to be dealt with, and require full-time SCBA use—and truly promote that everyone goes home safely.