By Matthew Alba
On a spring evening this March, beneath the chandeliers of San Francisco’s historic Palace Hotel, hundreds will gather to celebrate a milestone: the 20th anniversary of the San Francisco Firefighters Cancer Prevention Foundation (SFFCPF). Founded in 2006 by Captain (ret.) Tony Stefani after his own battle with a rare cancer, the SFFCPF was the first organization of its kind in the United States dedicated solely to preventing firefighter cancer. In the two decades since its humble launch, this once small volunteer-led effort has grown into a national beacon, pioneering research, changing policies, and, most importantly, saving lives in the fire service.
A mission born from the firehouse
The SFFCPF’s origin is a story of turning personal adversity into community action. In the mid-2000s, Captain Stefani noticed an epidemic of cancer among his fellow firefighters. After yet another funeral for a colleague lost to cancer, Stefani approached the local firefighters’ union with an idea to address the crisis.
With support from union members, Station 1 firefighters and UCSF oncologist Dr. Marshall Stoller, the Foundation was formed with a bold goal: prevention, education and early detection of cancer in the fire service.
“The things we were trying to accomplish had never been done before in the fire service,” recalls SFFD Deputy Chief of Administration Tom O’Connor, one of the founding board members — and the Foundation’s work quickly gained momentum. By 2013, it was featured in the HBO documentary “Toxic Hot Seat,” which brought international attention to firefighter cancer risks.
“From that moment forward, it was full speed ahead .... The ‘little’ foundation started by Tony Stefani has become a giant,” O’Connor reflects, adding that today SFFCPF is “the national leader addressing cancer in the fire service.”
Crucially, the Foundation has always been sustained by people on the front lines. An unpaid, all-volunteer board of active and retired firefighters (along with supportive civilians) guides its work.
From day one, SFFCPF built partnerships — with the San Francisco Fire Department (SFFD), Local 798 union, top universities, medical centers and government agencies — to bring the best science and resources to bear on this issue. This collaborative spirit, driven by firefighters’ firsthand experiences, is what makes the Foundation unique. It operates independently as a 501(c)(3) nonprofit (no city funding), ensuring its sole allegiance is to firefighter health. What began as a small group determined to “do something about” a growing tragedy has evolved into a powerhouse of cancer prevention.
Pioneering research and early detection
From its inception, SFFCPF recognized that understanding the problem was the first step to solving it. It was long suspected that firefighters, regularly exposed to smoke and toxic substances, faced higher cancer rates — and the Foundation set out to prove it.
In 2007, partnering with UCSF’s Department of Urology, SFFCPF conducted its first targeted cancer screenings. The results were eye-opening: A peer-reviewed study revealed significantly higher rates of genitourinary cancers among firefighters, including multiple cases of an otherwise rare bladder cancer (transitional cell carcinoma) in SFFD members. This early finding established a direct correlation between firefighting and elevated cancer risk, validating firefighters’ concerns with hard data.
Over the next two decades, the Foundation spearheaded an unprecedented series of scientific studies and screening programs. In 2010, SFFCPF collaborated with the National Institute for Occupational Safety and Health (NIOSH) on a groundbreaking cohort study of 30,000 firefighters from San Francisco, Chicago and Philadelphia, which eventually confirmed higher cancer incidence and mortality rates in firefighters compared to the general population.
In 2012, alarmed by a cluster of breast cancer cases among the city’s female firefighters, SFFCPF helped launch the Women Firefighter Biomonitoring Collaborative with the University of California – Berkeley, the first research project to investigate chemical exposures in women firefighters.
That same year, Stefani testified before the U.S. Senate about firefighters’ heavy exposures to flame retardants and other toxins, bringing the issue to the national policy arena.
Many “firsts” followed. SFFCPF funded a pioneering study measuring flame-retardant chemicals in firefighters’ blood in 2013 (led by Dr. Susan Shaw), which found alarmingly high levels and helped push California to curb toxic flame retardants. And the Foundation organized regular screening clinics — for cancers of the bladder, colon, skin and more — offered at little or no cost to active and retired firefighters. Foundation-sponsored screenings have detected cancers at early stages that might have otherwise gone unnoticed, undoubtedly saving firefighters’ lives. One major initiative in 2022 provided 1,786 members with an advanced multi-cancer blood test, identifying 11 firefighters with early cancer signals who could then get timely treatment. Such programs underscore SFFCPF’s philosophy that early detection is critical in a profession where aggressive cancers often strike at young ages.
The impact of this work is clear. Over 20 years, SFFCPF has supported hundreds of firefighters and family members through the gauntlet of cancer diagnoses and treatment. It has funded over a dozen major studies in partnership with UCSF, Stanford, Harvard and others, greatly expanding scientific understanding of firefighter health risks.
Just as importantly, the Foundation’s findings have driven changes in how firefighters do their job. For example, after studies showed dangerous contamination on gear and equipment, the SFFD issued new policies, from a stricter overhaul procedure in 2016 to rigorous fireground decontamination rules in 2019, to reduce members’ toxin exposure. When data revealed unusually high cancer rates in women firefighters, the department invested in better-fitting protective gear and facilities for female members. And in 2015, scientific evidence gathered by SFFCPF helped prompt Mayor Ed Lee to sign California’s Firefighters Cancer Presumption Act, strengthening line-of-duty cancer protections for firefighters.
Each study, each screening, each policy change has been a building block in a safer future. As the Foundation proudly notes, its efforts have informed multiple SFFD policy updates; informed national, state and local legislation; and even spurred new state research funding to combat firefighter cancer.
Leading the charge for PFAS-free gear
One of SFFCPF’s most game-changing initiatives in recent years has been the fight to eliminate PFAS — the aptly named “forever chemicals” linked to cancer — from firefighters’ protective gear. For decades, firefighters wore turnout coats and pants imbued with PFAS chemicals in moisture barriers and coatings. Tragically, the very gear that shielded firefighters from flames was quietly harming them with toxic chemicals.
The Foundation had long raised alarms about these “legacy” turnouts. Backed by years of advocacy and evidence, San Francisco took bold action. In 2024, the City became the first in the nation to ban the use of PFAS in firefighter clothing. A local ordinance set a mid-2026 deadline for SFFD to transition entirely to PFAS-free ensembles. The Foundation played a crucial role in this effort, rallying firefighters and working with city leaders to prioritize firefighter health.
The results of that advocacy are now on full display. By December 2025, San Francisco firefighters had fully switched over to new-generation turnout gear free of PFAS. With help from a FEMA grant and City funds, SFFD procured 1,100 sets of PFAS-free gear, enough to outfit every frontline firefighter. This makes SFFD the largest fire department in the United States to adopt non-PFAS gear, setting a precedent for others to follow.
“This step places San Francisco at the forefront of firefighter safety,” Mayor Daniel Lurie declared at a 2025 press briefing, flanked by rows of firefighters in their new beige-colored turnouts.
Fire Chief Dean Crispen credited a strong, coordinated effort among the fire department, City Hall, the firefighters’ union, and the SF Firefighters Cancer Prevention Foundation for making the transition possible. In short, SFFCPF helped prove that if safer gear exists, firefighters and their families deserve nothing less.
This local progress fueled a broader movement. California lawmakers, with support from firefighter advocates, took the fight against toxic gear statewide. In October 2025, Governor Gavin Newsom signed Assembly Bill 1181 into law — landmark legislation requiring that all new firefighting protective equipment in the state be free of PFAS and other harmful flame retardants. The law directs Cal/OSHA to update safety standards by 2027 so that outdated requirements for PFAS-laden materials are eliminated. Manufacturers will have to certify that their gear is PFAS-free, and existing gear will be phased out over the coming years. This is a huge victory that codifies years of firefighter advocacy and scientific evidence about PFAS’ dangers. It positions California as a national leader in firefighter safety, extending earlier state bans on PFAS firefighting foam to now include the gear firefighters wear every day. The SFFCPF applauded the passage of AB 1181 and continues working with fire service partners to ensure these new standards are implemented smoothly. Thanks in no small part to the Foundation’s persistence, a future where no firefighter has to wear a toxic jacket is finally on the horizon.
Of course, eliminating carcinogens from gear and the fireground is only half the battle. The sobering reality is that since 2006, approximately 400 San Francisco firefighters have died from cancer — a devastating toll that underscores why this work is literally life-saving.
“The cost of inaction is measured in funerals,” says Steve Gilman, 10th District Vice President for the IAFF.
Each reform that SFFCPF has championed, from cleaning up diesel exhaust in firehouses to securing funding for advanced screening, has aimed to turn the tide on those numbers. And with firefighting now officially classified as carcinogenic to humans by the World Health Organization’s research arm, the Foundation’s mission has never been more urgent or more validated by science.
Firefighters and families: Stories of survival
Behind every statistic, there are faces and families — and the Foundation’s impact is perhaps best told through their stories. SFFCPF not only works on broad prevention strategies, it also provides direct support to any firefighter (active or retired) and family member confronting cancer.
In 2012, the Foundation established a Health Navigation program that has become a lifeline for hundreds of families. The concept was pioneering: Assign knowledgeable “navigators” — often retired firefighters or nurses — to personally guide cancer patients through the maze of doctors, treatments and paperwork. These navigators jump into action the moment a firefighter is diagnosed, helping with everything from securing second opinions at top hospitals to arranging financial aid for experimental treatments. They stand by the firefighter (or spouse or child) every step of the way, so no one fights cancer alone.
Furthermore, eligibility isn’t limited to San Francisco. Since 2020, the program expanded to serve firefighters across the Bay Area and their immediate families. It’s a labor of love that the Foundation considers just as important as the research it funds.
The gratitude from those helped by SFFCPF is profound.
“Receiving a cancer diagnosis as the reason behind all the health issues your 5-month-old baby has been experiencing is one of the scariest moments parents can face,” shared SFFD Firefighter/Paramedic Phanh Le, whose infant son was diagnosed with cancer. “Judy from the Foundation called me and said something I’ll never forget: ‘Be with your son. Let the doctors do what they need to do. Send us whatever you can, whenever you can. We’ll take care of the rest.’ SFFCPF didn’t just help our family; they stood with us. Every step of the way.”
The Foundation absorbed the logistical and financial burdens so that Phanh could focus on his child — an act of compassion he shared that he and his family will never forget.
Stories like this are common.
“As a female firefighter, I have faced my share of challenges, but nothing prepared me for the fight against cancer,” recalls SFFD Firefighter Cristina Zammarchi. “The Cancer Prevention Foundation, led by Tony Stefani, stood by me every step of the way. Judy Lynch was my lifeline, helping me navigate the system, understand my options and stay strong through treatment. Thanks to their support and the best medical care, I didn’t just get through cancer, I beat it. I will always be grateful for the endless work they do for firefighters like me.”
Cristina’s successful recovery is a testament to the power of early detection and expert guidance.
And the Foundation’s support crosses city lines as well. When Oakland firefighter Mike Espinueva was diagnosed, SFFCPF extended its hand to him too, even though he worked for a different department, guiding him through specialist referrals and decision-making until he, like Cristina, emerged on the other side of illness.
To date, the Health Navigation team has assisted over 375 individuals, including more than 200 San Francisco firefighters and 125 of their family members, with everything from cutting-edge treatments to emotional support groups. They have secured integrative oncology services, connected brain tumor patients with peer mentors, and helped survivors transition into life after cancer. Perhaps just as crucial, the Foundation has cultivated a sense of family within the fire service — a promise that “we take care of our own.” That peace of mind is invaluable in a job as dangerous as firefighting.
Honoring the champions of firefighter health
The upcoming Igniting Hope Gala will not only celebrate the Foundation’s 20-year journey, it will also shine a spotlight on some of the heroes who have helped make that journey possible. SFFCPF will honor three esteemed medical partners with its White Helmet Award for their “longstanding, expert treatment and compassionate care” of firefighter patients. Dr. Maxwell V.
Meng, Dr. Matthew Gubens, and Dr. Sima Porten — all renowned UCSF physicians — will be recognized for the extraordinary care they’ve provided to firefighters battling cancer. Dr. Meng and Dr. Porten, leading urologic oncologists, have been instrumental in the Foundation’s early screening programs for genitourinary cancers (like the landmark 2007 bladder cancer study) and have treated countless firefighters with kidney, prostate and bladder cancers. Dr. Gubens, a thoracic oncologist, is a specialist in lung cancer — a disease that has struck firefighters at higher rates — and has guided many through advanced therapies. Together, these doctors have given SFFD members and their families not just medical expertise but also hope and personal commitment. They are, in many ways, the guardian angels on the other side of a 911 call — the ones who rescue those who save others. The Gala is SFFCPF’s way of saying thank you.
The Foundation’s success has always been a team effort, reliant on partnerships across many fields. In addition to the honorees, SFFCPF works closely with researchers at institutions like UCSF, Stanford, Harvard and UC Berkeley to push firefighter health science forward. It partners with organizations like the International Association of Fire Fighters (IAFF) and the California Professional Firefighters (CPF) on advocacy, and with city leaders on implementing safety measures. Local 798 has been a crucial ally from day one, joining forces with SFFCPF to champion measures like city-funded routine cancer screenings for all firefighters. Industry innovators have stepped up too: Textile and gear manufacturers collaborated with the Foundation during the transition to PFAS-free gear, proving that when a city of San Francisco’s stature demands safer products, the industry listens.
The Igniting Hope Gala will bring many of these partners together under one roof — a night to honor all those who have lent their expertise, resources and heart to the cause.
A legacy of service and a call to action
As the San Francisco Firefighters Cancer Prevention Foundation reaches its 20th anniversary, it stands as a remarkable example of what a small group of committed individuals can achieve. Tony Stefani, now in his 70s, still serves as Foundation President. His vision, born from personal adversity and profound love for his fire service brothers and sisters, has created an enduring legacy. Generations of firefighters will live longer, healthier lives because of what he and the founding board set in motion.
The Foundation’s volunteer Board of Directors today includes veteran firefighters, passionate community members bringing expertise in medicine, science and advocacy. All are united by a shared mission — to ensure that those who risk their lives for the public do not lose their own lives to the very profession they love.
The broader significance of SFFCPF’s work extends far beyond San Francisco. Fire departments across the country have begun replicating its initiatives, from decontamination routines now standard after fires, to cancer awareness training in academies, to other cities exploring their own firefighter cancer foundations. Nationally, the IAFF has made cancer prevention a top priority, echoing many practices first tested in San Francisco. Perhaps most telling, in 2022 the International Agency for Research on Cancer (IARC) officially classified the occupation of firefighting as Group 1 (Carcinogenic to Humans), putting it in the same category as asbestos exposure and tobacco smoke. This designation, influenced by studies that SFFCPF and its partners contributed to, validates what firefighters have known: Cancer is as much an enemy as any flame. But thanks to the progress of the past 20 years, firefighters now have better armor in this fight, scientifically, medically and through a supportive community.
The Foundation has become a beacon of dedication and progress, safeguarding the health of those who risk their lives to protect the community. There is much to honor, and still much to do.
New challenges lie ahead, from understanding how to further reduce exposures to helping firefighters navigate novel cancer therapies. Yet the tone of the upcoming Gala is not one of fear or sadness; it is one of hope — hope ignited by knowledge, by hard-won victories and by the camaraderie of the firefighting family.
As the SFFCPF prepares to commemorate its 20th anniversary at the Igniting Hope Gala on March 28, 2026, it extends a warm invitation to all who care about firefighters and public health. This celebratory evening at the Palace Hotel is more than a fundraiser; it’s a tribute to resilience and a rallying cry for the future. Readers are encouraged to join in support, whether by attending the gala, sponsoring a firefighter’s ticket, or simply spreading the word about the Foundation’s life-saving mission.
Two decades ago, San Francisco’s firefighters lit a spark of change. Today that spark has grown into a flame of hope, illuminating a path forward where fewer firefighters will hear the words “you have cancer,” and every firefighter knows that an entire community stands behind them. After 20 years of progress, the message burns brighter than ever: We are here for you — will you be there for us?
ABOUT THE AUTHOR
By Matthew Alba is battalion chief with the San Francisco Fire Department Division of Health, Safety & Wellness.
