Something was wrong.
Steve Azzarella wasn’t sleeping. He’d gained 30 pounds in the first few months of 2019 and his feet were hurting so badly he had a hard time walking. The 10-year veteran of the Charleston Fire Department wondered if he had arthritis, so he went to see a doctor.
Tests showed his joints were fine, but a blood test showed abnormal thyroid hormone levels. An ultrasound discovered a nodule on the right side of the gland; a biopsy revealed the final diagnosis in March — thyroid cancer.
“When you get that phone call … it kind of is a gut punch,” Azzarella said. “I’m 44 years old. I’ve dreamt of being a fireman since I was 18 years old. This is the only thing that I wanted to do with my life.”
For the Charleston firefighter and others like him, cancer is a job risk that’s increasingly worrisome. Soot, smoke and other carcinogenic compounds abound at fires. The deaths of 9/11 first responders elevated the issue to national attention and prompted, in part, many states to pass presumption laws.
The legislation generally states that if a firefighter is diagnosed with cancer while actively serving or within a certain time after retiring, the illness is presumed to be work-related. Proponents say the laws help open the door for workers’ compensation assistance that can help ease financial burdens on sick firefighters and their families.
All but two states have passed presumption laws or some other kind of cancer protection bills for firefighters: Delaware and South Carolina.
Going from his feet hurting to a cancer diagnosis in the span of a few months was a shock, Azzarella said.
The right side of his thyroid was taken out, but doctors at Medical University Hospital discovered the cancer had started to spread to his lymph nodes. A second surgery removed the other half of his thyroid. Doctors found more abnormal cells in his lymph nodes. The cancer was more aggressive than originally thought.
After the surgeries, doctors scheduled him for radiation treatment. He was declared cancer-free in August and cleared to return to work.
While the immediate threat of disease has passed, Azzarella said the financial burden on his family has been significant. Over the course of his treatment, the firefighter used 300 hours of sick leave accumulated over his 10 years with the Charleston Fire Department. By the end, he had to start using his vacation time, as well.
And medical costs added up quickly.
“Just those burdens alone were more stressful than dealing with the actual procedure and the cancer itself,” Azzarella said. ”(It) was worse and kept me up more at night than the actual fact that I had cancer because I had faith in the doctors … but those bills are never going to go away until they’re paid.”
In order to protect firefighters like Azzarella, S.C. Rep. Nancy Mace, R-Daniel Island, and Bill Pesature, vice president of the Professional Fire Fighters Association of South Carolina, are leading efforts to get a cancer presumption bill passed.
Mace said she was approached by Pesature last year. Their conversations turned to the issue of cancer protections.
“It’s cumulative,” Pesature said. “The problem is in today’s environment, everything that’s laminate is oil-based, and that stuff burns hotter. It burns faster and it has more off-gas, and that stuff we absorb. We’re not protected because of a mask. We’re protected (in) our lungs and our breathing, but the rest of us is exposed to it because it’s smoke. It gets anywhere it wants to get.”
Firefighters in the Palmetto State have protections if they come down with heart disease or respiratory illnesses, Mace said.
But they are at increased risk of a variety of cancers, from breast to colon.
“We’re doing an enormous disservice to those people by not helping find coverage for them on something like cancer that they’ve likely contracted on the job,” Mace said.
She introduced a bill expanding cancer presumptions during the last legislative session, but it never moved to a vote. Mace plans to bring the bill back in January.
“Right now, we just want to see the bill receive a hearing next year because it can take years for a bill to be signed into law,” she said. “We’re trying to start with what we believe should be … easier and extending it later. We’ve got to get a hearing first. We already want to amend it later down the road, too. How can we get the most done for the most people in the quickest amount of time — that’s my approach to legislation.”
The issue of whether to include volunteer firefighters has been a friction point with the South Carolina State Firefighters’ Association.
Brick Lewis, director of administration for that group, said his organization is also concerned about cancer risks among firefighters, but they have some reservations about the bill.
“We’re going to support anything that supports all of our firefighters,” Lewis said. “Our state is 65-70 percent volunteer firefighters, based off our 17,500-plus membership. With any presumption bill, we battled this before when it came to lung diseases. We ended up getting a presumptive legislation passed for that.”
South Carolina’s workers’ compensation is complex, and the State Firefighters’ Association wants to make sure than any effort to protect firefighters doesn’t cause a larger issue, he said.
Lewis pointed to reports from states like California and Texas where firefighters’ workers’ compensation claims under cancer presumption laws have faced significant challenges or been denied.
“Just because you checked that box, if it doesn’t have any teeth, then it doesn’t do any good,” he said. “We want to make sure that what’s proposed is best for all firefighters.”
Despite his cautious approach, Lewis said he and his organization are not sitting idly.
“We don’t need to just say this’ll happen eventually,” he said. “We need to continue to work with our legislative partners and the governor.”
Lewis’ organization is also collecting data on firefighter cancer that they hope will be able to help guide policy and improve safety.