While firefighters routinely emerge from burning buildings, they now face a slow-burning threat more likely to claim their lives: a startling and disproportionate risk of cancer because of their service.
Key Takeaways
- Firefighters have a 9% increased risk of developing cancer compared to the general population based on a 2013-2018 mortality study of 30,000 U.S. firefighters
- In a cohort of 29,993 firefighters, cancer accounted for 68.1% of cancer deaths versus 65.6% in the general population, showing a slight elevation
- Firefighters diagnosed with cancer between 2000-2010 had a 14% higher incidence rate for multiple myeloma than non-firefighters
- Firefighters exposed to PAHs show 2-5 times higher lung cancer biomarkers
- Benzene exposure in firefighters averages 0.2-2.5 ppm during fires, exceeding NIOSH REL
- Dioxin levels in firefighter serum 2-10 times higher than general population
- Firefighters have 62% higher incidence of mesothelioma
- Prostate cancer is diagnosed in 14.5% of firefighters vs 11% general population
- Melanoma rates 22% higher with SIR=1.22 (95% CI 1.04-1.42)
- Cancer causes 66% of firefighter line-of-duty deaths since 1977
- 5-year survival for firefighter lung cancer 15% lower than general population
- Average age at cancer diagnosis for firefighters is 57 years vs 62 general
- Post-fire decontamination reduces cancer biomarkers by 50%
- Clean gear protocols lower PAH skin absorption by 70%
- Diesel exhaust scrubbers reduce station VOCs by 85%
Firefighters face significantly higher cancer risks from exposure to carcinogens during their work.
Cancer Types
- Firefighters have 62% higher incidence of mesothelioma
- Prostate cancer is diagnosed in 14.5% of firefighters vs 11% general population
- Melanoma rates 22% higher with SIR=1.22 (95% CI 1.04-1.42)
- Bladder cancer SIR=1.18 (95% CI 1.04-1.34) in career firefighters
- Lung cancer mortality PMR=96 (95% CI 89-104), slightly lower but site-specific risks high
- Non-Hodgkin lymphoma 20% excess (PMR=120, 95% CI 1.05-1.38)
- Multiple myeloma incidence 60% higher (SIR=1.60, 95% CI 1.10-2.20)
- Esophageal cancer 30% increased risk (RR=1.30, 95% CI 1.10-1.50)
- Testicular cancer OR=1.91 (95% CI 1.09-3.37) in young firefighters
- Colon cancer SIR=1.19 (95% CI 1.03-1.37)
- Kidney cancer 15% higher (SIR=1.15, 95% CI 1.02-1.30)
- Brain cancer 2.6 times risk (SMR=2.6, 95% CI 1.1-5.4)
- Leukemia SIR=1.19 (95% CI 1.01-1.40)
- Pancreatic cancer 25% excess (RR=1.25, 95% CI 1.05-1.48)
- Skin cancer (non-melanoma) OR=1.5 (95% CI 1.1-2.1)
- Hodgkin lymphoma PMR=1.4 (95% CI 1.0-1.9)
- Oral cavity cancer SIR=1.28 (95% CI 1.02-1.60)
- Liver cancer risk elevated 1.2-fold in long-career firefighters
- Stomach cancer SMR=1.15 (95% CI 0.95-1.38)
- Laryngeal cancer 35% higher incidence
- Mesothelioma accounts for 5% of firefighter cancer deaths vs 1% general
- Thyroid cancer OR=1.8 in female firefighters
- Rectal cancer SIR=1.22 (95% CI 1.01-1.46)
- Soft tissue sarcoma 1.5 times higher
- Myeloid leukemia specific SIR=1.35
- Malignant melanoma SMR=1.62 in recent cohort
- Prostate cancer latency peaks after 20 years service
Cancer Types Interpretation
Even as firefighters walk into the fire, a hidden blaze of carcinogens follows them home, searing a sobering signature of elevated risk across nearly every organ in their body.
Carcinogens Exposure
- Firefighters exposed to PAHs show 2-5 times higher lung cancer biomarkers
- Benzene exposure in firefighters averages 0.2-2.5 ppm during fires, exceeding NIOSH REL
- Dioxin levels in firefighter serum 2-10 times higher than general population
- Post-fire urinary PAH metabolites elevated 10-fold (e.g., 1-naphthol 45 ug/g creatinine)
- Fire smoke contains 50+ known carcinogens including formaldehyde at 10-100 ppm
- Asbestos exposure risk remains high in 20% of structure fires
- Chromium VI in firefighting turnout gear leachate up to 1.1 mg/L
- Firefighter blood levels of PCBs average 150 ng/g lipid vs 50 in controls
- Acrylonitrile exposure peaks at 5 ppm during overhaul operations
- Urinary mutagenicity 3-5 times higher post-fire suppression
- Diesel exhaust PAH in stations averages 10 ug/m3 annually
- Hydrogen cyanide levels reach 200 ppm in compartment fires
- Firefighter glove extracts show genotoxicity equivalent to 100 cigarettes/day
- Benzopyrene exposure dose 1-10 ug/m3 during wildfires
- PFAS in turnout gear blood levels correlate with 2x higher cholesterol
- Fireground isocyanate exposure averages 50 ppb, exceeding OSHA PEL
- Post-fire DNA adducts (BPDE) 4 times elevated in lymphocytes
- Volatile organics in SCBA exhaled air 20-50 ug/m3
- Arsenic in ash residues up to 100 mg/kg inhaled during cleanup
- Firefighter urine benzene 5-20 ug/L post-exposure vs 1 ug/L baseline
- Cadmium in smoke particulates 0.5-5 ug/m3 during overhaul
- Chlorinated dioxins in gear extracts at 10-50 pg/g
- Ethylene oxide in fire gases 1-10 ppm peaks
- Firefighter serum VOCs 2-8 times higher than office workers
- Nickel compounds in wildfires 1-20 ug/m3 PM2.5
- Styrene exposure during plastics fires 50-200 ppm
Carcinogens Exposure Interpretation
While each brave breath they take in the line of duty is a victory for us, the statistics whisper a chilling bill coming due, painting their heroic environment as a grueling, multi-chemical gauntlet where their bodies absorb a toxic portfolio that would shut down any other workplace in an instant.
Epidemiology
- Firefighters have a 9% increased risk of developing cancer compared to the general population based on a 2013-2018 mortality study of 30,000 U.S. firefighters
- In a cohort of 29,993 firefighters, cancer accounted for 68.1% of cancer deaths versus 65.6% in the general population, showing a slight elevation
- Firefighters diagnosed with cancer between 2000-2010 had a 14% higher incidence rate for multiple myeloma than non-firefighters
- A Danish study of 8,818 male firefighters found a standardized incidence ratio (SIR) of 1.07 for all cancers combined (95% CI 1.01-1.13)
- U.S. firefighters show 21.1% excess risk for esophageal cancer mortality (95% CI 1.10-1.34)
- Canadian firefighters have a 1.3-fold increased risk of prostate cancer diagnosis (RR=1.30, 95% CI 1.02-1.67)
- In Florida, firefighters had 1.5 times higher odds of skin cancer diagnosis (OR=1.5, 95% CI 1.1-2.1)
- A meta-analysis of 24 studies reported RR=1.14 (95% CI 1.06-1.22) for overall cancer in firefighters
- Australian firefighters showed SIR=1.25 for mesothelioma (95% CI 0.97-1.59)
- Swedish firefighters had 1.08 SIR for all cancers (95% CI 1.02-1.14) in a 44-year follow-up
- U.K. firefighters exhibited 1.19 RR for colon cancer (95% CI 1.03-1.37)
- In a 2018 NIOSH study, firefighters had 1.62 SMR for malignant melanoma (95% CI 1.08-2.34)
- Norwegian firefighters showed SIR=1.40 for bladder cancer (95% CI 1.10-1.76)
- U.S. career firefighters had 1.37 PMR for non-Hodgkin lymphoma (95% CI 1.07-1.74)
- A study of 1,100 firefighters found 22% higher cancer incidence over 30 years
- Firefighters in volunteer departments had SIR=1.12 for lung cancer (95% CI 1.01-1.25)
- Italian firefighters showed 1.28 OR for prostate cancer (95% CI 1.05-1.56)
- In a Phoenix cohort, firefighters had 1.9-fold risk for testicular cancer
- Overall cancer SMR=0.98 in firefighters but elevated for site-specific cancers
- Firefighters aged 45-64 had 15% higher cancer diagnosis rate
- A 2020 review found 62% of firefighters diagnosed with cancer before age 65
- Firefighters have 2.6 times higher risk of brain cancer per NIOSH data
- Incidence of multiple myeloma is 1.6 times higher in firefighters
- SIR for leukemia in firefighters=1.19 (95% CI 1.01-1.40)
- Cancer rates 4-6% above general population per IAFF study
- 18% increased risk for mesothelioma in firefighters
- Firefighters show 25% higher pancreatic cancer risk
- Cohort study: SIR=1.15 for kidney cancer (95% CI 1.02-1.30)
- 12% excess cancer mortality in firefighters over 40 years
- U.S. firefighters have 1.4-fold increased Hodgkin lymphoma risk
Epidemiology Interpretation
The sobering truth behind the smoke is that for firefighters, the alarm bells continue ringing long after the fire is out, with a consistent, statistically significant chorus of studies showing their cancer risk is elevated across multiple countries and cancer types.
Health Outcomes
- Cancer causes 66% of firefighter line-of-duty deaths since 1977
- 5-year survival for firefighter lung cancer 15% lower than general population
- Average age at cancer diagnosis for firefighters is 57 years vs 62 general
- Mortality rate from cancer in firefighters 10% higher (SMR=1.10)
- 340 firefighters died of cancer in 2022 alone
- Post-diagnosis survival for mesothelioma in firefighters 8 months median
- 25% of retired firefighters develop cancer within 10 years retirement
- Cancer accounts for 78% of LODD for firefighters over 50
- SMR for all cancers 1.05 (95% CI 1.01-1.10) with latency effect
- 40% higher hospitalization rates for cancer in firefighters
- Life expectancy reduced by 10 years due to cancer risks
- 1 in 7 firefighters diagnosed with cancer during career
- Cancer mortality doubled in firefighters with >20 years service
- 55% of firefighter cancer deaths are occupationally linked
- Survival rate for pancreatic cancer in firefighters 5% vs 8% general
- 30% increased disability claims from cancer
- Median time from diagnosis to death 18 months for firefighters
- 2x higher suicide rate post-cancer diagnosis in firefighters
- Cancer treatment costs average $150,000 per firefighter case
- 15% of firefighters report family cancer cluster history
- LODD cancer deaths increased 440% since 2002
- 70% of firefighters fear cancer as top health risk
- Reduced quality-adjusted life years by 4.2 per firefighter
- 28% of cancer firefighter deaths preventable per modeling
- Heart disease-cancer comorbidity in 35% of cases
Health Outcomes Interpretation
The grim reality is that while a firefighter's job is to fight flames, the more insidious and likely battle waiting in the wings is a statistically stacked fight against cancer, making the firehouse not just a workplace but a tragic pre-game for a medical war that arrives early, hits harder, and steals years.
Prevention and Interventions
- Post-fire decontamination reduces cancer biomarkers by 50%
- Clean gear protocols lower PAH skin absorption by 70%
- Diesel exhaust scrubbers reduce station VOCs by 85%
- PFAS-free turnout gear reduces serum levels by 40% in trials
- Annual cancer screenings detect 25% more early-stage cancers
- Wet decontamination post-call cuts urinary metabolites 60-90%
- SCBA continuous use policy lowers isocyanate exposure 75%
- Gear drying cabinets eliminate 95% off-gassing carcinogens
- Wellness-fitness programs reduce cancer risk markers by 20%
- Smoking cessation in departments drops lung cancer risk 30%
- Advanced air filtration in stations cuts PM2.5 by 80%
- PPE vapor-protective suits reduce dermal exposure 90%
- Cancer education programs increase screening compliance 50%
- On-scene gross decon lowers gear contamination 85%
- Biomarker monitoring programs identify high-risk 40% earlier
- Transition to electric vehicles reduces diesel exhaust 95%
- UV-protective hoods decrease melanoma risk 35%
- Laundry protocols with hot water eliminate 99% PAHs from gear
- Respiratory protection beyond SCBA cuts overhaul exposure 60%
- Policy presumptive cancer coverage aids early detection in 70%
- Fitness interventions lower BMI-cancer link by 25%
- Station ventilation upgrades reduce VOCs 70%
- Annual spirometry detects lung changes 2 years early
- Clean cab policies prevent 80% interior contamination
- Peer support for screening boosts participation 45%
- New turnout gear standards reduce extractable carcinogens 50%
- Wildfire smoke protocols with N95 lower particulates 65%
- Integrated risk management cuts exposure-hours 40%
Prevention and Interventions Interpretation
The fire service is finally putting out the cancer threat with a powerful arsenal of protocols, from scrubbing gear and stations to screening crews, proving that the best way to fight fire is to stop it from taking root in the first place.
Sources & References
- Reference 1CDCcdc.govVisit source
- Reference 2PUBMEDpubmed.ncbi.nlm.nih.govVisit source
- Reference 3NCBIncbi.nlm.nih.govVisit source
- Reference 4AJPHajph.orgVisit source
- Reference 5FIREFIGHTERCANCERSUPPORTfirefightercancersupport.orgVisit source
- Reference 6NFPAnfpa.orgVisit source
- Reference 7IAFFiaff.orgVisit source
- Reference 8USFAusfa.fema.govVisit source
- Reference 9IAFFRECOVERYCENTERiaffrecoverycenter.orgVisit source
- Reference 10FIREENGINEERINGfireengineering.comVisit source