Burning structures collapsing and trapping firefighters, wildfires killing hotshot crews and similar tragedies grab the public’s attention. But a more significant threat is lurking, taking firefighter lives — the health effects of firefighter exposure to combustion byproducts of burning materials, including carcinogens.

The impact on health can occur in everything firefighters do, from the knockdown when the fire is controlled and the overhaul when the structure is examined for potential areas that could reignite to their return to the station where particulate matter is carried in on gear, equipment, and bodies. In the course of their work, firefighters are frequently exposed to a variety of agents classified by the International Agency for Research on Cancer (IARC) of the World Health Organization as known or probable human carcinogens.

Robert Young is the president of Fairfax County Professional Firefighters and Paramedics, International Association of Firefighters (IAFF) Local 2068. According to Young, the hazardous synthetic chemicals known as PFAS, or polyfluoroalkyl compounds, are released when firefighters douse blazes. Firefighters are exposed to toxic chemicals in the burning furnishings and building materials. They come into contact with the chemicals by breathing them in, getting them on their skin or in their eyes, or ingesting them. "They're even found in the gear we wear to protect ourselves," Young said.

Minimizing carcinogen exposure is crucial. Fairfax County and other departments encourage firefighters "to shower within the hour" to reduce exposure to carcinogens and potential carcinogens. Young said that the Fairfax County Fire Department and Local 2068 focus on decontamination, containment, including removing gear to minimize contamination and decontaminating and bagging their self-contained breathing apparatus (SCBA) for professional cleaning. All firefighters now have two turnout gear sets.

Fairfax firefighters are not wearing their gear as frequently as they have in the past to reduce exposure. Firefighters can determine the level of protection they require based on the information provided at the time of dispatch. "Fire in a house? We definitely put it on," Young said.

At the 2023 IAFF Fallen Firefighter Memorial Ceremony, nearly 66 percent of the names added to the wall between Jan. 1, 2021, and Dec. 31, 2022, were those who died from occupational cancers — pancreatic, throat and ovarian.

“Cancer caused 70 percent of the line-of-duty deaths for career firefighters in 2016. Firefighters have a 9 percent higher risk of being diagnosed with cancer than the general U.S. population. Firefighters have a 14 percent higher risk of dying from cancer than the general U.S. population,” according to the nonprofit Firefighter Cancer Support Network.

According to IAFF in “Global Health Organization Links Fire Fighting and Occupational Cancer,” the International Agency for Research on Cancer (IARC), the cancer agency of the World Health Organization, re-evaluated firefighting reporting in 2022. It stated, “For decades, the IARC had classified firefighter occupational exposures as Group 2B, meaning the exposures were possibly carcinogenic. The new classification, Group 1 — carcinogenic to humans, now puts firefighting on a par with tobacco and benzene.” A summary of the final evaluations is published online in “The Lancet Oncology.”

When these protective ensembles become readily available, I hope to see the fire service as a whole transition away from the gear that is laden with these carcinogens to something that is going to not only protect us from the products of combustion but also protect us from this gear that is also contributing to the occurrence of cancer in the fire profession,” Young said.

Medical screening is vital because the sooner cancers are detected, the better the overall outcome. In January 2023, the Fairfax County Fire and Rescue Department (FCFRD) was awarded the Federal Emergency Management Agency Assistance to Firefighters Grant $450,000 to provide ultrasound diagnostic scan screenings. The scans encompass an echocardiogram, carotid doppler, abdominal aorta, thyroid, liver, gallbladder, spleen, bladder, and kidney scans, as well as testicular scans for men and exterior pelvic scans for women. It allows for the early detection of cancer and other health conditions. All current firefighters and those who have retired within the last five years are eligible for free cancer detection scans. 

Steve Weissman is currently serving as the Virginia state director for the Firefighter Cancer Support Network. Wiseman said they ensure that when members are diagnosed, they don't fight that fight alone. Support is there if the firefighter wants it. Weissman retired as a deputy fire chief with the Stafford County Fire and Rescue Department and started his career with the Fairfax County Fire and Rescue Department. 

Diagnosed in 2016 with prostate cancer through early detection, Weissman said he turned to the Firefighter Cancer Support Network for assistance. ”Lo and behold, I’m part of the group that grabbed me, brought me, and supported me. Now I’m giving back.” Weissman said that numbers put things in perspective, and not all firefighters diagnosed with cancer reach out to them because “it’s personal.”

“So last year [2023] in Virginia, we had 57 firefighters diagnosed with cancer, 16 for Fairfax County, one as young as 28, and some retirees. The average age of a firefighter dying of cancer last year was 57 years old,” Weissman said. “In Virginia, we had seven firefighters die of cancer, two from the City of Alexandria.”

The Fallen Firefighter Memorial is in the shadow of Pikes Peak in Colorado Springs. It honors the sacrifices made by IAFF members who died in the line of duty. Among the names added in July of 2023, the wall bears the inscription "Kimberly A. Schoppa, IAFF Local 2068, Fairfax County, VA, 04/22/2022." The fatal injury cause, according to the IAFF, is "contact or exposure." Schoppa died of ovarian cancer at 49.

Ryan McGill is a master technician for Fairfax County Fire and Rescue. He serves as director for IAFF Local 2068, chairman of the Firefighter Cancer Reduction Committee, and is on the board of directors for the Virginia Professional Firefighters Charitable Foundation. McGill urges current and former career and volunteer firefighters to take the foundation’s survey.

The purpose of the survey is to generate data to identify the number of Virginia firefighters with cancer, the types of cancers they have, and ways to mitigate cancer risk among Virginia’s firefighters. The data provided will also help with legislative initiatives to reduce exposures, provide early detection screenings, and fund firefighter cancer research.

McGill said Local 2068 did an internal survey. "[It was] the first in the state to conduct a survey of their membership to determine the scope of cancer,” McGill said. “We had about 457 people take our survey, and we have 96 people reporting having cancer,” McGill said. “It’s a big number — active and retired members. However, in many recent cases, they were caught early through ultrasound screenings.”

Through legislation, more compensable cancers are covered. During the last legislative session, thyroid cancer screening was added. "Virginia Professional Firefighters are bringing forward legislation this session, in 2024, to ensure that every firefighter career or volunteer can get early detection cancer screening,” McGill said.

McGill said they are working with the Inova Schar Cancer Institute, to greet their members on their cancer journey as they arrive for surgery.

Ray Lankin, CEO of United Diagnostic Services, LLC, said in an email that, in addition to the direct exposure risks, lifestyle factors can potentially undermine the effectiveness of protective gear and decontamination procedures. According to Lankin, promoting a healthy lifestyle in fire departments, including regular exercise and a balanced diet, is essential to reducing firefighter cancer risk. Educational programs addressing lifestyle factors are crucial to comprehensive cancer prevention efforts in the firefighting community and beyond.

Cancer and Firefighters

In 2023 in Virginia, 57 firefighters were diagnosed with cancer; 16 in Fairfax County, one as young as 28, and some retirees. The average age of a firefighter dying of cancer last year was 57 years old. In Virginia, we had seven firefighters die of cancer, two from the City of Alexandria.

— Steve Weissman, Virginia state director, Firefighter Cancer Support Network