Firefighters for Prevention

Lt. Heather Buren, a firefighter for the San Francisco Fire Department, which has high rates of breast cancer. She doesn’t want to sit back and wait for a cure– she wants to prevent breast cancer.

Cancer in the fire service

In the past several years, firefighters made significant gains regarding cancer prevention and awareness. In Boston, Seattle, San Francisco, Arizona, and Florida, major departments began to recognize and address high rates of cancer among firefighters.

In 2006, retired SFFD Captain Tony Stefani created a leading organization in this movement, the San Francisco’s Cancer Prevention Foundation (SFFCPF). SFFCPF and the United Fire Service Women (UFSW) brought attention to concerns about breast cancer among female firefighters in the San Francisco Fire Department.

Of San Francisco’s approximately 225 female firefighters–the most of any major city–a number of women have faced breast cancer diagnoses. Most of the women received their diagnosis before menopause, which is rare in the population as a whole.

What we know

Women are not included in most studies of firefighters’ health. In our review of the literature on firefighters and cancer, only three out of 20 studies evaluated women firefighters’ cancer risk.

When they are included, the number of women is often too small to draw reliable conclusions. This is true for racial and ethnic backgrounds among both male and female firefighters as well. Often the numbers of black, Latino or Asian firefighters included in studies are too small to evaluate if they face unique health risks.

Based on what we know from the few studies of women firefighters, overall cancer incidence appears elevated. Of the specific cancers studied, cervical, thyroid, and bladder cancer were elevated at a statistically significant level and breast cancer appears elevated, although this was not statistically significant. No other specific cancers have been studied in women.

Cancers that are elevated in male firefighters, but have not been studied in women, include brain cancer, colon cancer and kidney cancer as well as leukemia, Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.

We don’t know if women have elevated risk of these cancers because studies haven’t looked at rates of these cancers among women. In this case, we can’t use the absence of data to say there is an absence of risk.

What we are doing

Since 2013, BCPP has partnered with the Women Firefighters Biomonitoring Collaborative (WFBC), a project of the Women Workers Biomonitoring Collaborative (WWBC). The WFBC, comprised of firefighters from SFFCPF and UFSW, researchers from UC-Berkeley, UCSF, and Silent Spring Institute, and advocates from BCPP and Commonweal, collected blood and urine from firefighters in 2014. Researchers analyzed the blood and urine samples for the presence of PFAS chemicals and other chemicals of concern and wrote up their findings in this article: Exposure to Perfluoroalkyl Substances in a Cohort of Women Firefighters and Office Workers in San Francisco.

The study specifically measures exposures to PAHs (which are products of combustion), PFAS chemicals (which are common in firefighting foams and household and commercial products), and flame retardants. In addition, Time of Flight technology was used to assess exposure to other chemicals linked to breast cancer.  It concludes that women firefighters are exposed to higher levels of some PFAS chemicals compared to office workers, suggesting that some of these exposures may be occupationally related.

Policy

On September 30, 2020, California Governor Gavin Newsom signed SB 1044 into law, a bill that banned toxic PFAS “forever” chemicals known as PFAS from firefighting foam used to fight flammable liquid fires. SB1044 was co-sponsored by Breast Cancer Prevention Partners, California Professional Firefighters, Clean Water Action, Environmental Working Group and NRDC.

PFAS in firefighting foam is a major source of drinking water contamination in the state and poses a risk to communities where firefighting foam is used and to the firefighters who use the foam. Safe, effective, and economical alternatives are available and in widespread use. The new law imposes some of the strongest restrictions in the nation. In California, water sources for water systems serving up to 19 million people have already been found to be contaminated with PFAS. Given that the state still has to conduct tests on many more drinking water sources, the number is likely much higher. PFAS contamination is very hard to contain and clean up can be expensive.

The Firefighter Cancer Registry Act of 2018 collects data on all firefighters, include women, minorities, and volunteer firefighters. This will provide the data we need to be able to know more about the rates of cancer among those who are excluded, or included in small numbers, in other studies.

Presumptive laws are regulations that assume a given disease is linked, by default, to a specific occupation. This means that when someone is diagnosed with an illness covered under a presumptive law, they are automatically entitled to disability or workers’ compensation, medical expense coverage, and medical leave. Without presumptive laws, firefighters and other workers may have to prove that their line of work caused their disease to get these benefits—a process that can be lengthy and expensive at a time when resources need to go toward treatment, wellness and sometimes end-of-life decisions.

Only eleven states and one Canadian province proactively include breast cancer in presumptive laws: Arkansas, Idaho, Iowa, Maine, Maryland, Missouri, New Mexico, New York, Oregon, Virginia, Wisconsin, and Ontario.

The City and County of San Francisco presumes that cancer that develops during service in the Fire or Police Department arose due to employment, as long as the individual has served for more than five years.