The men and women who run into burning buildings have a dangerous job in more ways than one. Their occupation also puts them at higher risk for several kinds of cancer.
Firefighters, in particular, and other first responders are at higher risk of developing myeloma, lymphoma and cancer in the breast, lungs, skin, liver, testes and other organs, says Mary Reid, MSPH, PhD, Chief of Cancer Screening, Survivorship and Mentorship at Roswell Park Comprehensive Cancer Center.
“There is exposure to a lot of different chemicals that are aerosolized and volatized by fire, and depending on what’s burning, it can be heavy metals, it can be building materials that contain stuff we don’t know about but are highly flammable; there’s arsenic, there’s petrol, diesel. Firefighters get exposed, even when they’re using their masks and respirators appropriately,” Dr. Reid says. Fire also breaks the chemical bonds that hold together different compounds, all of which can be breathed into a person’s lungs and cause inflammation that could lead to bigger problems, including cancer.
“The chemicals get into your system and you metabolize them and then your organs and fat stores are exposed to them and they can accumulate there. If you’ve been a firefighter for 20 years or more, you really start to see the risk increase,” she says. “The longer folks are working, the more fires you respond to, the different characteristics you’re exposed to, the higher your risk.”
Chemicals don’t just come into the body through the lungs — skin plays a big role in cancer risk and exposure for firefighters as well. That’s why Roswell Park is teaming up with the Firefighter Cancer Foundation of NY, an organization started by Syracuse firefighter Mike Valenti, to encourage first responders to schedule cancer screenings. He started the organization following the deaths of three firefighters in that city, all from cancer, within less than a calendar year. All three men were longtime firefighters and in their early 50s.
“Cancer was never discussed with firefighters up until the last few years,” Valenti says. “It was a badge of honor to be the dirtiest person at a fire. Dirty gear and helmets were a sign that someone worked hard at a fire. That has changed. Now we are teaching firefighters about the dangers and the hazards of our job when they get hired. The older firefighters are seeing what is happening. They see their friends getting sick and don’t want to have that happen to them. We are constantly trying to come up with new ideas to keep ourselves safe and healthy.”
Early detection means early treatment, better outcomes
The most important message is to come in and get all applicable screenings as soon as possible, starting with a skin cancer screening. “Imagine if you’re a 30-year firefighter and your neck is exposed at every fire you went to, every time. Even if skin cancer doesn’t develop, those chemicals are landing there and being absorbed into your body,” Dr. Reid says.
Urging firefighters to get screened is a hard message to get across for people who willingly risk their lives and safety as a regular part of their livelihood. “These are not the people who go to the doctor for a hangnail,” Dr. Reid says. “They’re tough! But they need to take care of themselves and come in for a screening. They can come into Roswell Park, and we’ll look at the entire person, their skin, do a full physical, help with bloodwork and get them into any screenings they need.”
“You don’t want to be the guy that sits back and waits to see a doctor,” Valenti says. “We are making the screenings available to them at earlier ages. We have changed our health insurance so that the screenings are covered at earlier ages. We teach them that an early diagnosis is so important. It could be the difference between life and death.”
Routine cancer screenings can help find small problems before they grow into bigger, more serious ones. Dr. Reid says that all jobs put people at risk for health problems and cancer, including her job where she spends a lot of time sitting at a desk, but she makes a point to get an annual mammogram because she knows it’s an important component of early detection. Firefighters and other first responders also have high-stress jobs and “we know that stress, chronic inflammation, can increase your risk of cancer.”
Clean equipment mitigates risk
They also stress the importance of properly using and cleaning all equipment needed to go into burning buildings. “In the summer, it’s not uncommon to see firefighters without their coats on because it’s hot. With the recent fire in the Bronx, I saw firefighters bundled up but didn’t see any wearing their respirators and it was a very smoky environment. They have to wear their equipment. They also need two sets of equipment because the chemicals can settle on their gear and, if they’re not cleaned properly, those chemicals will linger and be inhaled, but that doesn’t happen everywhere.”
The exposure to these chemicals is cumulative, meaning the longer a person is on the job, the more these cancer-causing chemicals can build up in the body, especially in fatty tissue to which these chemicals are drawn like a magnet, Valenti explains. “As soon as we walk into the firehouse, we are building up our exposure to chemicals, between the diesel exhaust, flame retardant materials in our uniforms to the toxins at every fire call and hazardous materials call we go to. We need to keep up on our screenings. There’s also a five-year window after retirement: Once we retire, a firefighter is covered by the presumptive cancer bill for five years. After that time, a firefighter will not be able to say their cancer is necessarily job-related. That’s another reason why we need regular screenings throughout our career, to catch that early diagnosis.”
Fear of the unknown is understandable
He tells his firefighter colleagues that having concerns or fear about getting screened is understandable and normal. Fear of the unknown is something firefighters deal with every time they go into a burning building, but that’s different from possibly hearing bad news from a doctor. But it’s better to know, and find out early than to let a problem go untreated.
Firefighters are also informed that, just by doing their job, they can take up to a decade off their lifespan. “If we want to enjoy our retirement, we need to protect ourselves early,” Valenti says. It is up to each person to be their own advocate to being healthy, and that starts with cancer screenings.”