Protecting female firefighters from occupational cancer
What fire departments can do to help shield members from elevated cancer risks
Learning of the recent death of Sacramento Firefighter Tami Thacher from job-related cancer sent me back to a report published earlier this year by the U.S. Fire Administration (USFA) titled Emerging Health and Safety Issues Among Women in the Fire Service. That report covers a variety of topics but includes one chapter focused on women firefighters’ specific risks regarding cancer.
Unfortunately, that chapter does not draw many definitive conclusions, mainly due to the lack of medical studies that deal explicitly with women’s risk. Such studies are hard to come by due to the numbers: Women still comprise less than 5% of career firefighters nationwide and less than 10% of all firefighters. Their presence on departments is so dispersed and their risk factors from service so widely variable that it is hard to make conclusive statements from the available data.
Fire service cancer incidence and presumption laws
It is now accepted that firefighters generally have an increased cancer risk due to work-related exposures to toxic products of combustion as well as other hazardous substances. Statistically valid studies have linked certain types of cancers to job-related exposures. Federal and state laws reflect these conclusions, including the Firefighter Registry Cancer Act of 2018 and the James Zadroga 9/11 Health and Compensation Reauthorization Act.
Most states have some sort of cancer presumption laws that apply to firefighters, although the conditions dictated in these laws can vary widely. For example, some laws cover only certain cancers. Some states limit how long after retirement a cancer diagnosis is covered. Very few states with such laws name cancers that primarily affect women, such as breast, ovarian or cervical cancer, although some early studies see a higher incidence of these cancers among women firefighters.
Elevated risk for women
The USFA report links to two studies that suggest that women firefighters might be at increased risk for breast, cervical, thyroid and bladder cancers. However, because sample size is so small and most previous cancer studies among firefighters included only men, the conclusions regarding women firefighters are still considered preliminary.
However, some disturbing news has been reported on this front. The San Francisco Fire Department includes over 225 women, approximately 16% of its workforce. Of that number, 15% of female firefighters between 40 and 50 years old have been diagnosed with breast cancer, which is six times the national average.
Women firefighters may be at equal or increased risk of job-related cancer for several reasons. Some of the known carcinogens that firefighters routinely encounter, including endocrine-disrupting chemicals, may affect women differently. But there are no studies yet to confirm or deny this.
Additionally, women firefighters must often use protective gear that does not fit them well, allowing increased exposures while on emergency scenes. Women still frequently lack immediate access to shower facilities in fire stations, delaying or preventing rapid decontamination after exposures.
Protecting women firefighters
There are significant challenges to studying women firefighters as a unique risk group. Numbers and geography are big hurdles. The willingness to gather data and network using technology and linked databases will help, and the new national cancer registry is a good start.
Expanding state cancer presumption laws to be gender-inclusive is another important step, and some jurisdictions, such as the City of San Francisco, have taken the lead by instituting such laws at the local level.
Fire departments can reduce cancer risks among their members by ensuring that all firefighters have access to equipment, resources and knowledge that will protect them from the hazards they routinely face. All firefighters need to be educated about the short- and long-term hazards they face in the job. Organizations must develop policies and protocols regarding the use, transportation, storage and cleaning of PPE – and consistently enforce those policies. Properly fitting gear must be supplied to all members. Access to effective decontamination, including showers in stations, must be the norm for everyone. And departments should participate in data-gathering efforts to further clarify specific risks.
Fighting fire is a dangerous job, but some risks of the work can be mitigated through information and consistent safe practice. And as with everything, good leadership is the key to making it happen.