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.
“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.
“When you’re fighting fires, it’s hard not to get dirty, and we acknowledge that. But what we can do is get clean fast.” MONTGOMERY COUNTY DIVISION CHIEF CHARLES BAILEY
“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.”