Firefighting is a profession built on bravery and dedication, with individuals routinely confronting hazardous situations to protect communities. These acts of service come with unique occupational health challenges. An elevated risk of cancer has emerged as a significant concern, prompting extensive research and preventative efforts within the fire service.
Understanding the Elevated Risk
Research consistently demonstrates that firefighters face an increased risk of cancer compared to the general population. The National Institute for Occupational Safety and Health (NIOSH) conducted a large-scale study of nearly 30,000 career firefighters, revealing a 9% higher rate of cancer diagnoses and a 14% higher rate of cancer-related deaths. These findings align with other comprehensive analyses, including a meta-analysis of 32 studies, further solidifying the link.
The International Agency for Research on Cancer (IARC), part of the World Health Organization, has classified occupational exposure as a firefighter as “carcinogenic to humans” (Group 1). This classification is based on sufficient evidence linking firefighting to specific cancer types. Many jurisdictions have implemented presumptive legislation, which presumes certain cancers diagnosed in firefighters are work-related. Currently, 48 U.S. states and Washington, D.C., have enacted some form of presumptive legislation for firefighter cancer.
Key Exposure Pathways and Carcinogens
Firefighters encounter a complex array of hazardous substances, primarily from combustion byproducts during fire suppression and overhaul. Modern structures, often containing synthetic and plastic materials, produce more smoke and a wider range of carcinogens than natural materials. These substances include known human carcinogens such as benzene, polycyclic aromatic hydrocarbons (PAHs), formaldehyde, 1,3-butadiene, dioxins, and asbestos. Diesel exhaust from fire apparatus also contributes to exposure at fire scenes and within fire stations.
Carcinogens enter the firefighter’s body through several pathways. Inhalation of smoke, gases, and particulate matter is a direct route, allowing absorption into the bloodstream. Dermal absorption, or skin contact, is another significant pathway, as contaminants can permeate through personal protective equipment (PPE) or transfer directly to the skin. Ingestion can occur through hand-to-mouth transfer of contaminants from soiled gear or surfaces. Even after a fire is extinguished, off-gassing from contaminated equipment can continue to release hazardous vapors.
Common Cancers Affecting Firefighters
A range of cancers have been consistently linked to firefighting, showing elevated rates among those in the profession. Mesothelioma, a cancer strongly associated with asbestos exposure, has been found at twice the rate in firefighters compared to the general U.S. population. Bladder cancer also shows sufficient evidence of increased risk.
Other cancers with consistently elevated rates include:
Testicular cancer, with some studies indicating a risk more than double that of the general population.
Non-Hodgkin lymphoma and multiple myeloma, often around 50% higher.
Prostate cancer, brain cancer, and certain gastrointestinal cancers like colon and rectal cancer.
Skin cancer, including malignant melanoma.
Prevention and Mitigation Strategies
Reducing cancer risk in firefighters involves a multi-faceted approach focusing on minimizing exposure to carcinogens. A primary strategy is the consistent use of full personal protective equipment (PPE), including self-contained breathing apparatus (SCBA), throughout all phases of firefighting, from initial attack to overhaul and investigation. SCBA should be worn until all on-scene decontamination is complete, as contaminants remain airborne even after the fire is out.
Decontamination procedures are also crucial. On-scene gross decontamination, involving rinsing and scrubbing gear with soap and water, can remove a significant percentage of contaminants. After gross decontamination, gear should be sealed in bags for transport to prevent cross-contamination of apparatus cabs and fire stations. Firefighters should use wipes on exposed skin areas like the head, neck, and hands immediately after incidents and shower thoroughly within an hour of returning to the station to remove absorbed toxins. Station hygiene, including dedicated exhaust capture systems for vehicles and proper ventilation, further reduces exposure to diesel fumes and other airborne contaminants. Regular health screenings and documentation of all fire and chemical exposures are also important for early detection and tracking.