How firefighters’ life-saving work puts them at a higher risk of cancer

Amna Nawaz:

The life expectancy for firefighters is 10 years less than the average person. And it's not just the fires themselves that present dangers.

Firefighters are frequently exposed to toxic chemicals. And, according to recent research, even their protective gear may carry health risks.

Stephanie Sy went to San Francisco to look into so-called forever chemicals and their possible effects on these essential workers.

Stephanie Sy:

Fire Station 1 in downtown San Francisco is among the busiest firehouses in the country, on a typical weekday, a flurry of calls, responders jumping into action. Few firefighters will ever tell you they dreamed of doing anything else.

Tony Stefani, San Francisco Firefighters Cancer Prevention Foundation:

I loved it. I loved every day.

Stephanie Sy:

Tony Stefani spent more than half his career at Station 1.

Tony Stefani:

It was nonstop, and you wanted to be able to go out and help people.

Stephanie Sy:

But, in 2001, he was blindsided and forced into early retirement.

Tony Stefani:

At the gym where I was working out, I started to urinate blood. Within a week or two, I was — I found out that I had a tumor in my kidney and had to had my kidney removed.

So, my doctor at UCSF told me that the type of cancer I had is normally found in people that are heavy smokers or are in the chemical industry. I was neither.

Stephanie Sy:

But chemicals are part of firefighting. And chemicals can lead to cancer. According to data collected by the International Association of Firefighters, the majority of active-duty firefighters aren't killed by fires, but by cancer. They have a 14 percent higher chance of dying from cancer than the general public.

Jeanine Nicholson, Chief, San Francisco Fire Department:

When we were sworn in, when we were in the tower, never once thought of cancer. And then I remember during my career hearing about people who were retired or who had a lot of time in the job dying from cancer. But I never related it to, like, that's not going to happen to me.

Stephanie Sy:

But Jeanine Nicholson, the chief of the San Francisco Fire Department, was not spared.

Jeanine Nicholson:

Ten years ago, I had just gone through a double mastectomy for breast cancer and would then start my first of 16 rounds of chemo in September 2012.

Stephanie Sy:

Over the years, awareness has spread about the hazards of certain flame-retardant materials that, when burned, produce toxic smoke.

More recently, a commonly used firefighting foam has come under scrutiny. It contains extremely high levels of perfluorinated chemicals known by their acronym, PFAS, or PFAS.

They have been manufactured by 3M and DuPont since the 1940s. And they take so long to break down, they are called forever chemicals. They are in everything from nonstick cookware to raincoats. As a result, almost all of us have traces of PFAS in our blood.

But researchers say firefighters are exposed to much higher levels, including in the protective gear they're required to wear.

Dr. Kari Nadeau, Stanford University:

We do know enough to be able to say that, for firefighters, we need to protect them better.

Stephanie Sy:

Kari Nadeau and Mary Prunicki at Stanford University are researching the impacts toxic smoke and PFAS have on firefighters' health.

Dr. Kari Nadeau:

We can see the degree by which these exposures of PFAS has affected their cells and their DNA. It's possible to find the footprint of one chemical vs. another on the DNA of a person. And that will really help us know, after chronic exposures, to what degree is a cancer and a firefighter associated with PFAS?

Tony Stefani:

I think the PFAS chemicals did play a role, absolutely, in the type of cancer that I was diagnosed with. After I went through treatment and the diagnosis of cancer, within a five-year period, four more firefighters at Station 1 contracted transitional cell carcinoma, the same type of cancer that I had.

Stephanie Sy:

Stefani often had to handle the PFAS-laden foam that the industry is trying to find a replacement for, but not even he knew until recently that firefighting suits, called turnout gear, also contain a high amount of the chemicals.

Matthew Alba, Battalion Chief, San Francisco Fire Department:

Teflon is in between the moisture barrier and the thermal liner.

Stephanie Sy:

Oh, OK.

Teflon is a PFAS chemical. Battalion Chief Matthew Alba says, for all the occupational hazards that can't be eliminated, PFAS in turnout gear can and should be. In late August, the International Firefighters Union advised members to wear turnout gear only when necessary.

Matthew Alba:

It won't be truly PFAS-free until that Teflon barrier is taken away.

Stephanie Sy:

The National Fire Protection Association is looking at the issue. Gear standards are set by volunteer committees, which include manufacturers and firefighting officials.

The association's Chris Dubay is a neutral facilitator.

Chris Dubay, National Fire Protection Association:

The standard does not specify what chemicals, what products, what technology manufacturers use to comply with those performance requirements. They establish the performance requirements.

Stephanie Sy:

Do you think that the standard may change as a result of this public pressure?

Chris Dubay:

The committee is already proposing changes in response to what you're hearing, what you're concerned about, what your listeners are concerned about, and what we're concerned about, about having the best PPE available for firefighters to keep them safe.

Stephanie Sy:

In a statement to the "NewsHour," 3M said: "Global health agencies and researchers acknowledge the limited nature of evidence indicating that PFAS cause harmful effects for specific health endpoints."

But Alba doesn't trust the chemical industry.

Do they have your best interests in your health at heart?

Matthew Alba:

I want to say yes, but the evidence is pointing to no. They are treating us as expendable people, and that's just not acceptable to me.

Stephanie Sy:

Alba was diagnosed with brain cancer in 2020 at the age of 43. He attributes that not solely to PFAS, but to the chemicals he was exposed to when he fought the devastating Camp Fire in Paradise, California, two years earlier.

Matthew Alba:

I always assumed I would get cancer. I think the toxins that I was that our crews were subjected to definitely played a factor. At the Camp Fire, there was no escaping the smoke. An inversion layer trapped the smoke. And we were breathing that fire for eight days without respiratory protection.

Stephanie Sy:

And when the wildfires meet areas of urban development, all the chemicals in burning houses create even more toxic dangers to firefighters on the scene.

Mary Prunicki, Stanford University:

When you're firefighting, when you breathe the smoke, it's like getting a big dose of air pollution all at once.

Stephanie Sy:

While the research on wildfire smoke and PFAS is not quite as conclusive as it is for, say, tobacco or asbestos exposure, the Environmental Protection Agency recently proposed designating some PFAS as hazardous substances.

Stanford researcher Mary Prunicki says understanding what dosage can lead to disease is key.

Mary Prunicki:

What would be really nice is if we could figure out a way to look at someone's blood and say, OK, you have had enough exposure. If you don't stop now, you're going to have dire health consequences down the line.

Stephanie Sy:

Several months ago, Tony Stefani's cancer came back, this time in his bladder, although you would never know it from watching the 71 year old crush a workout.

Do you have any regrets?

Tony Stefani:

None. I would do it again, yes.

Stephanie Sy:

Even though you have lost a kidney to it?

Tony Stefani:

Yes. I'm still active. It has not stopped me from doing what I want to do. I don't even think about it, to tell you the truth.

Stephanie Sy:

Chief Nicholson says firefighting is still the greatest job in the world. And she and Matthew Alba are working together to prevent more firefighters from going through what they had to.

Jeanine Nicholson:

But really, it's about stopping it on the front end. And that's where the huge challenge is.

Stephanie Sy:

After over 20 years fighting fires, Battalion Chief Alba's brain tumor has stopped him from returning to the front lines.

Matthew Alba:

I get exhausted and fatigued, and I have trouble concentrating. I wouldn't feel comfortable being in front of a fire with my challenges in communicating. It just wouldn't be right.

My heart will always be in the field.

Stephanie Sy:

And he says he finds comfort knowing he can be an advocate for firefighters in the field in his new role, the official in charge of health, safety and wellness for the San Francisco Fire Department.

For the "PBS NewsHour," I am Stephanie Sy in San Francisco.