Ig­nit­ing fo­cus on fire­fighter can­cer

Baltimore-area de­part­ments rec­og­nize risk, move to in­crease pro­tec­tion

Baltimore Sun Sunday - - FRONT PAGE - By Alison Kneze­vich

The first time Amy Dant was di­ag­nosed with can­cer, she thought it was bad luck. The sec­ond time, she sus­pected some­thing else: that the job she loved was mak­ing her sick.

The now 43-year-old Baltimore res­i­dent has fought fires since she was 19, first as a vol­un­teer and then as a ca­reer mem­ber of the Mont­gomery County Fire and Res­cue Ser­vice. When she signed up, she didn’t know that fire­fight­ers have a higher risk of can­cer than the gen­eral pub­lic.

“I had no idea. None,” said Dant, now a lieu­tenant for the Mont­gomery depart­ment who has sur­vived cer­vi­cal and thy­roid can­cer and even­tu­ally re­ceived work­ers’ compensati­on cov­er­age. “I don’t re­call it ever be­ing spo­ken about.”

But that is chang­ing, as aware­ness grows in fire­houses and government of­fi­cials com­mit money to re­search­ing the con­nec­tion and buy­ing new equip­ment to re­duce fire­fight­ers’ risk.

A fed­eral fire­fighter can­cer reg­istry is in the works to help sci­en­tists mon­i­tor the disease and track links be­tween fire­fight­ers’ ex­po­sures to car­cino­gens and in­ci­dence of can­cer. Mary­land re­cently ex­panded work­ers’ compensati­on pro­tec­tions for fire­fight­ers, adding more types of can­cer to the list of those con­sid­ered to be oc­cu­pa­tional dis­eases. Lo­cal fire de­part­ments in Mary­land say they are try­ing to re­duce their per­son­nel’s ex­po­sure to car­cino­gens by fund­ing new equip­ment and chang­ing

poli­cies.

For in­stance, Anne Arun­del County fire­fight­ers now ex­change their hoods — the gar­ments they wear un­der their hel­mets — for a clean one right af­ter a fire, of­fi­cials say. The Baltimore City Fire Depart­ment is among those pur­chas­ing spe­cial laun­dry equip­ment for turnout gear, as the coats and pants worn to fires are called. Since 2016, Mont­gomery County has re­quired fire­fight­ers to con­tinue wear­ing their breath­ing masks post-fire as they ex­am­ine burned ar­eas for re­main­ing sources of heat.

Re­search from the Na­tional In­sti­tute for Oc­cu­pa­tional Safety and Health found that fire­fight­ers had a 9% higher risk of be­ing di­ag­nosed with can­cer and 14% higher risk of dy­ing from it.

When com­mon ma­te­ri­als burn, they can pro­duce toxic con­tam­i­nants, in­clud­ing those known to cause can­cer, that can seep into fire­fight­ers’ skin or be in­haled. These sub­stances coat the pro­tec­tive gear the fire­fight­ers wear, which can spread the con­tam­i­na­tion to fire­houses, per­sonal ve­hi­cles and homes. And the diesel fumes from their trucks are also linked to can­cer.

“We can’t take away ev­ery ex­po­sure, but we can do more than what we’re cur­rently do­ing,” said Howard County Fire Chief Christine Uhlhorn.

This sum­mer, the Howard depart­ment de­buted its first “clean cab” fire truck at its new sta­tion near Mer­ri­weather Post Pav­il­ion.

The new ve­hi­cle keeps con­tam­i­nated gear — like breath­ing tanks, gas mon­i­tors and flash­lights — in a sep­a­rate com­part­ment rather than the cab itself.

The county plans to even­tu­ally re­place or retro­fit all its en­gines with clean cabs, Uhlhorn said. The new truck cost about $634,000, which she said is on par with a tra­di­tional en­gine.

Uhlhorn’s fa­ther, who re­tired as a Baltimore fire cap­tain, died of brain can­cer in 2007. She said she’s watched many colleagues suc­cumb to the disease.

The NIOSH study, com­pleted in 2015, in­cluded 30,000 fire­fight­ers from the Chicago, Philadel­phia and San Fran­cisco fire de­part­ments who worked be­tween 1950 and 2010. Fire­fight­ers were more likely than the U.S. pop­u­la­tion as a whole to be di­ag­nosed with di­ges­tive, oral, res­pi­ra­tory and uri­nary can­cers.

News re­ports of can­cer ap­pear­ing in first re­spon­ders in the 9/11 ter­ror­ist at­tacks also helped spur aware­ness, fire of­fi­cials say.

“It’s so preva­lent, you can’t ig­nore it,” Uhlhorn said.

Howard is an early adopter of clean cabs, but de­part­ments around the Baltimore re­gion say they are tak­ing steps to re­duce risks. Spe­cial cleans­ing wipes are widely used to help re­move soot and other par­tic­u­lates from fire­fight­ers’ skin af­ter a call. Sev­eral agen­cies plan to pur­chase com­mer­cial laun­dry equip­ment, known as ex­trac­tors, to clean gear.

Anne Arun­del County has ex­trac­tors at about a third of its sta­tions, fire depart­ment spokesman Capt. Russ Davies said.

In gen­eral, agen­cies are putting more em­pha­sis on rapid de­con­tam­i­na­tion af­ter fires.

“When you’re fight­ing fires, it’s hard not to get dirty, and we ac­knowl­edge that,” said Divi­sion Chief Charles Bai­ley of the Mont­gomery County depart­ment. “But what we can do is get clean fast.”

Some of the changes rep­re­sent a cul­ture shift for fire­fight­ers.

“It used to be that the dirt­ier your gear, the more macho,” said John Sibiga Jr., pres­i­dent of Lo­cal 1311, the Baltimore County chap­ter of the In­ter­na­tional As­so­ci­a­tion of Fire Fight­ers.

As part of the union’s lat­est con­tract, the county said it would fund a sec­ond set of turnout gear for each mem­ber, en­sur­ing they al­ways have a clean set af­ter calls. The county also said it would work to se­cure fed­eral grant funds to buy ex­trac­tors to clean fire­fighter gear in hopes of re­duc­ing ex­po­sure to car­cino­gens.

The Baltimore City depart­ment has pro­vided a sec­ond set of turnout gear for its per­son­nel for more than 15 years, said spokes­woman Blair Adams.

The Mary­land State Fire­men’s As­so­ci­a­tion, which rep­re­sents vol­un­teers, is also push­ing for more aware­ness, ad­vo­cat­ing for state fund­ing for can­cer screen­ings and other mea­sures.

Me­gan Richards, of Tow­son, won­ders if the pre­cau­tions taken to­day would have helped her fa­ther, Robert, who died of col­orec­tal can­cer in 2017 at age 65.

She said he ap­peared healthy in 2008 when he re­tired from a three-decade ca­reer with the Baltimore County Fire Depart­ment. He couldn’t wait to spend more time golf­ing. He was ec­static that his first grand­child was on the way.

But three months into his re­tire­ment, the Tow­son res­i­dent got the di­ag­no­sis.

“I think if he had done any­thing else with his life, we would not have lost him when we did,” Richards said.

Mary­land law con­sid­ers rec­tal can­cer to be an oc­cu­pa­tional disease for fire­fight­ers un­der cer­tain con­di­tions. It falls un­der the state’s can­cer pre­sump­tion law, mean­ing the disease is pre­sumed to be linked to firefighti­ng un­der cer­tain con­di­tions, which makes it eas­ier to get work­ers’ compensati­on ben­e­fits.

A new state law pushed by unions added three types of can­cers — blad­der, kid­ney and re­nal cell — to those cov­ered, bringing the to­tal num­ber to a dozen.

Some mu­nic­i­pal of­fi­cials have com­plained that the laws are too gen­er­ous and make it dif­fi­cult to chal­lenge claims in court be­cause a fire­fighter is cov­ered, even if he or she has risk fac­tors un­re­lated to their job, such as smok­ing.

Nei­ther of can­cers that Dant fought — thy­roid and cer­vi­cal — falls un­der the state’s pre­sump­tion laws.

Af­ter a work­ers’ compensati­on dis­pute with Mont­gomery County over whether her job caused the can­cer, she and the county set­tled the case, said her at­tor­ney, Ken Ber­man, of Gaithers­burg.

Mont­gomery County of­fi­cials de­clined to com­ment on the case, call­ing it a per­son­nel mat­ter. The set­tle­ment in­cluded cov­er­age of med­i­cal treat­ment and lost wages, Dant said.

But noth­ing makes up for the fact that treat­ment for her cer­vi­cal can­cer left her un­able to bear chil­dren.

She un­der­went a hys­terec­tomy at age 27. Grow­ing up in a fam­ily of five chil­dren, Dant al­ways en­vi­sioned hav­ing kids of her own.

Nine years af­ter doc­tors found the cer­vi­cal can­cer, she was di­ag­nosed with thy­roid can­cer.

Dant, who grew up near a fire­house in Takoma Park and was en­thralled with the en­gines that whizzed by her child­hood home, said her fam­ily has no his­tory of can­cer.

She said the scarcity of re­search on fe­male fire­fight­ers was an ex­tra chal­lenge in her case.

With the fire ser­vice tra­di­tion­ally dom­i­nated by white men, pre­vi­ous stud­ies have in­cluded small num­bers of fe­male and mi­nor­ity per­son­nel. Na­tion­ally, nearly 96% of ca­reer fire­fight­ers are men, and about 82% of ca­reer fire­fight­ers are white, ac­cord­ing to the Na­tional Fire Pro­tec­tion As­so­ci­a­tion.

Sci­en­tists hope a new na­tional ini­tia­tive will shed more light on can­cer in women and non-white fire­fight­ers — as well as vol­un­teer fire­fight­ers, who also have been un­der­stud­ied.

Last year, Pres­i­dent Don­ald Trump signed the Fire­fighter Can­cer Reg­istry Act, which re­quires the Cen­ters for Disease Con­trol to build a vol­un­tary data­base to mon­i­tor can­cer in the pro­fes­sion.

The reg­istry law re­ceived bi­par­ti­san sup­port and was sup­ported by groups such as the In­ter­na­tional As­so­ci­a­tion of Fire Fight­ers, the union rep­re­sent­ing some 300,000 mem­bers.

“It will give us un­de­ni­able data,” said IAFF spokesman Doug Stern, which is also push­ing for a fed­eral ban on a class of flame re­tar­dants that has been linked to can­cer in fire­fight­ers.

Re­searchers hope the reg­istry will pro­vide a large, di­verse sam­ple and help bet­ter iden­tify risk fac­tors that may be linked to can­cer, such as work­place prac­tices, said Miriam Siegal, lead epi­demi­ol­o­gist for the reg­istry project.

The new reg­istry will in­clude vol­un­teer fire­fight­ers.

It will likely be at least a year be­fore NIOSH is able to be­gin reg­is­ter­ing fire­fight­ers, said Kenny Fent, head of the reg­istry pro­gram.

Dant said she has found her purpose in ed­u­cat­ing oth­ers in the fire ser­vice and try­ing to pre­vent can­cer in her pro­fes­sion.

She now vol­un­teers with the Fire­fighter Can­cer Sup­port Net­work, a na­tional or­ga­ni­za­tion that pro­vides men­tors to fire­fight­ers with can­cer and their fam­i­lies. She also teaches can­cer preven­tion classes in her depart­ment.

But many fire­fight­ers still don’t ex­pect to get can­cer, she said.

“They don’t think it’s go­ing to hap­pen to them,” she said. “But at least they’re tak­ing note.”

KIM HAIRSTON/BALTIMORE SUN

Ja­cob Oursler, a Howard County Depart­ment of Fire and Res­cue Ser­vices fire­fighter re­cruit, places his self-con­tained breath­ing ap­pa­ra­tus on a slide out com­part­ment as he shows off the new “clean cab” en­gine at the sta­tion near Mer­ri­weather Post Pav­il­ion. Con­tam­i­nated gear is stored apart from where the fire­fight­ers sit, re­duc­ing their ex­po­sure to car­cino­gens.

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