The Numbers We Cannot Ignore
Cancer is now the leading cause of line-of-duty death in the American fire service. Not structure collapses. Not flashovers. Not apparatus accidents. Cancer.
In 2025, nearly 80% of line-of-duty deaths reported by the International Association of Fire Fighters were attributable to occupational cancer. The 2025 National Fallen Firefighters Memorial honored 140 firefighters, and the majority of those names were added because of cancer diagnoses linked to their service.
These are not abstract statistics. These are firefighters who responded to the same calls we all respond to, breathed the same smoke we all breathe, and wore the same gear we all wear. The difference between them and us is time and biology — and we have more control over the biology than most firefighters realize.
The 2025 ACS Study: 36 Years of Data
In 2025, the American Cancer Society published a landmark study that followed nearly 470,000 men over 36 years, comparing cancer outcomes among firefighters to the general population. The findings were stark:
- 72% higher risk of death from skin cancer (melanoma) compared to non-firefighters
- 40% higher risk of death from kidney cancer compared to non-firefighters
- Suggestive elevated patterns in prostate cancer, colorectal cancer, and lung cancer
The 72% figure for melanoma deserves specific attention. Melanoma is not typically associated with firefighting in the public imagination — most people think of lung cancer or mesothelioma when they think of occupational exposure. But the data is consistent: polycyclic aromatic hydrocarbons (PAHs), which are present in virtually every structure fire, are absorbed through the skin. The neck, the wrists, the jawline — every area where PPE coverage gaps exist becomes a route of dermal absorption.
The 40% kidney cancer elevation aligns with what we know about per- and polyfluoroalkyl substances (PFAS) and volatile organic compounds (VOCs) that are metabolized through the renal system. Firefighters' kidneys are filtering a concentrated toxic load, year after year, call after call.
What "Suggestive Patterns" Means
In epidemiological research, "suggestive" does not mean "uncertain." It means the data trends in a consistent direction but hasn't yet reached the statistical threshold of formal significance in this particular study. Given the biological plausibility — we know these carcinogens exist in fire smoke, we know firefighters are exposed to them, and we know they cause these cancers in laboratory models — the suggestive patterns for prostate, colorectal, and lung cancer should be treated as actionable intelligence, not dismissed as inconclusive.
The National Firefighter Registry: 40,000 and Counting
The CDC/NIOSH National Firefighter Registry (NFR) has reached a critical milestone: more than 40,000 firefighters have enrolled. This registry is the largest systematic effort to link firefighter work histories with state cancer registry data, creating a dataset that will power cancer research for decades.
Here's how it works: when you enroll, the NFR records your service history — years on the job, types of calls responded to, geographic region. That information is then cross-referenced with state cancer registries, which track every cancer diagnosis in the country. Over time, the NFR will produce the most comprehensive picture ever assembled of which cancers affect firefighters, at what rates, and with what exposure profiles.
If you haven't enrolled, I'm asking you directly: do it today. It takes about 20 minutes. The information you provide is confidential and protected under federal privacy law. You are not signing up for a study that will poke or prod you. You are contributing your data to a dataset that will protect firefighters who come after you. That's the same ethic that drives everything we do in this profession — leave it better than you found it.
Understanding the Exposure Pathway
To understand why firefighters develop cancer at elevated rates, you have to understand how carcinogens enter the body during fireground operations.
Inhalation
Even with SCBA, firefighters experience inhalation exposure during overhaul, during the transition from IDLH to non-IDLH atmospheres, and during vehicle fire operations where SCBA use has traditionally been inconsistent. The combustion products in modern structure fires — which contain synthetic materials, plastics, treated wood, and electronics — produce a complex mixture of carcinogens including benzene, formaldehyde, acrolein, hydrogen cyanide, and dozens of PAHs.
Dermal Absorption
This is the exposure route that the fire service underestimated for decades. Soot and combustion byproducts settle on skin, particularly in areas where PPE doesn't provide complete coverage — the neck, the wrists, the ears, around the SCBA facepiece seal. PAHs are lipophilic, meaning they dissolve readily in skin oils and are absorbed directly into the bloodstream.
Studies using wipe sampling have found measurable levels of carcinogens on firefighters' skin within minutes of fireground exposure. The concentrations increase with time on scene and decrease with prompt decontamination — which brings us to the most actionable prevention measure available.
Ingestion
Contaminated hands touching the face, eating or drinking on scene without decontamination, and cross-contamination from gear to living spaces all contribute to the ingestion pathway. This is the easiest route to interrupt, and yet it persists because of operational tempo and cultural norms that we must change.
What Departments Must Do
The data is mature enough to support immediate action. These are not experimental interventions — they are evidence-based practices that reduce carcinogen exposure.
- Gross decontamination on scene. Every fire. Every time. Wet decon of PPE before leaving the fireground. This removes the bulk of surface contaminants before they can be absorbed or tracked into the cab and the station.
- Clean cab policies. Contaminated PPE stays in exterior compartments, never in the crew cab. Some departments are installing air filtration systems in the cab as an additional layer of protection.
- Immediate skin decontamination. Baby wipes or decon wipes on the neck, wrists, face, and ears within 10 minutes of exiting the IDLH atmosphere. This is the single most impactful individual action a firefighter can take. Carry wipes in your gear.
- Two sets of PPE. One set in service, one set being cleaned. Wearing contaminated gear into the next fire re-exposes you to accumulated carcinogens. Departments that issue two sets of turnouts see measurably lower contamination levels on members.
- SCBA from start to finish. Not just during active fire attack. During overhaul. During investigation. During any operation where combustion products are present. The old practice of pulling your mask during overhaul to "smell for extension" is a carcinogen delivery system.
- Annual cancer screenings. Baseline physicals upon hire, with annual or biennial screenings focused on the cancers most associated with firefighting. Early detection saves lives — the five-year survival rate for stage I melanoma exceeds 99%. For stage IV, it drops below 30%.
The Role of PFAS
A growing body of research has identified per- and polyfluoroalkyl substances (PFAS) in firefighter turnout gear as an additional source of carcinogen exposure. PFAS are used in the moisture barriers and outer shells of many turnout ensembles because of their water-resistant and heat-resistant properties. However, these "forever chemicals" do not break down in the body and have been linked to kidney cancer, testicular cancer, and other malignancies.
The fire service is actively evaluating PFAS-free alternatives for turnout gear, and several manufacturers have begun offering PFAS-free options. This is an area where purchasing decisions made today will affect cancer outcomes twenty years from now.
The Human Cost
I've sat in oncology waiting rooms with firefighters who spent their careers protecting others and now need protecting themselves. I've watched 40-year-old lieutenants undergo chemotherapy. I've attended funerals where the cause of death was listed as cancer, not "line of duty" — because the system, as reflected in the USFA firefighter fatalities database, hadn't yet caught up to the science.
That's changing. The Honoring Our Fallen Heroes Act now recognizes 20 cancers as presumptively job-related for federal death benefits. State-level presumptive laws are expanding. The National Firefighter Registry is building the evidence base for the next generation of protections.
But policy changes don't prevent cancer. Behavior changes do. Every time you skip decon because the call was "just a car fire." Every time you throw contaminated gloves on the dash. Every time you pull your mask during overhaul because it's hot and uncomfortable. Each of those moments is a choice, and over a career, those choices accumulate.
A Call to Action
If you take one thing from this article, let it be this: enroll in the National Firefighter Registry. Go to the CDC/NIOSH NFR website and register. It takes 20 minutes. Your data, combined with the data of 40,000 other firefighters, will build the scientific foundation that protects the next generation.
If you take two things, add this: get screened. Talk to your department physician about a cancer screening protocol. If your department doesn't have one, advocate for it. The cost of a screening program is a fraction of the cost of a cancer treatment — and the survival rate difference between early and late detection is the difference between attending your kid's graduation and not.
We run into burning buildings for strangers. We can show up for our own health, too.
For more on fire service careers, health considerations, and the realities of the job, explore our career guides. If you're considering joining the fire service, start with our guide on how to become a firefighter — and know that taking care of yourself is not optional. It's part of the job.
Read more on our blog about the legislative efforts to protect firefighters from occupational cancer.