Everyone knows that firefighting is a dangerous job — jumping into burning buildings is not for the faint of heart. And because of the inherent risks and the important role they play for the public, it’s not surprising that firefighters are commonly viewed as heroes.

But not only do firefighters face potential death or injury in the line of duty — from the fires themselves, along with structural collapses, diesel exhaust, or even traffic collisions — they also face a hidden, longer-term hazard: occupational cancer, which now claims the lives of more firefighters than any other cause.

Although there are many factors that can lead to a cancer diagnosis, like genetics, lifestyle, or environmental factors, firefighters are diagnosed at a rate almost 10 percent higher than the general population and die from cancer at a rate nearly 15 percent higher. But it’s not just smoke inhalation. Every time a structure is on fire, it has the potential to release toxic chemicals and materials, both from the building itself and from what’s inside. According to Mike Bresnan, president of the International Association of Fire Fighters (IAFF) Local 22 in Philadelphia, “I’ve been in dwelling fires in Philadelphia where there are tires inside burning, there are swimming pools; the contents of the structure now, like the furniture, are all made of plastic — it’s almost like an oil fire. The soot gets on you, it’s all over your clothes, it gets absorbed by your skin. . . . You’re in a Crock-Pot of cancer soup.”

But it’s not just fires that release toxic chemicals — it’s also firefighters’ uniforms, which are filled with “forever chemicals” known as PFAS. Because firefighters are often sweating heavily on the job, the skin expands, making it more prone to absorption, which means that they’re absorbing more chemicals from the fire and from their gear. (For every five-degree increase in body temperature, skin absorption goes up 400 percent.) Additionally, wear and tear and heat on the gear has been shown to cause the release of even more PFAS.

For female firefighters, their protective gear can be even more dangerous, as uniforms are often designed for men’s bodies. Former Providence, Rhode Island, firefighter Donna MacDonald was diagnosed with cancer five years after she joined the force. While there’s no way to know for sure, she traces her diagnosis back to a chemical fire that she once fought. “It could have been accumulating over the five years, but at that particular fire, my gear was gaping and too big, and I broke out in a horrible rash all over my neck and chest. There were no machines to wash our gear and I didn’t have a second set, and the next day, I put the same gear on, and broke out into the same rash.”

One year later, MacDonald was diagnosed with a very rare type of bone cancer (chondrosarcoma) in her sternum — a strange place to find this already very rare cancer. She had her sternum removed and replaced with a prosthetic, and was able to rejoin the force — but after working for nearly ten more years, she ultimately had to retire early due to extreme pain. “I was devastated because I wanted to do thirty years on the job, I wanted to go through the ranks, but I only got fifteen,” she said. “I loved every minute of it, I miss it every day.”

In response to new research about PFAS in turnout gear, the IAFF has urged their members to limit the amount of time they wear it. Members should only wear their gear to a fire and then remove them as soon as possible, and they should seal gear in trash bags to transport it back to the station. Firefighters should also wear gear that fits them — such as “women’s cut” gear if necessary — along with their hoods (MacDonald was not wearing hers during the chemical fire).

The IAFF also suggests using body wipes immediately after exiting a fire and showering as soon as workers get back to the station. Ideally firefighters would have a second set of gear and also wash their uniforms after they have been worn in a fire, but both new uniforms and extractors — the washing and drying machines that clean safety gear — are expensive.

“Women’s cut” gear is also more expensive because there are generally fewer women firefighters in each location, so ordering in bulk isn’t as easy. A spokesperson for the IAFF told Jacobin that some local unions will oftentimes negotiate two sets of gear with their employers. Classes about safety and cancer are now available to every department, but there is also a cultural hurdle to making this change. MacDonald said that “many firefighters didn’t want to wash their gear. It’s like a badge of honor — the dirtier the gear, the harder you work.”

In March 2023, the IAFF sued the National Fire Protection Association for ignoring scientific evidence and downplaying the risks of PFAS. IAFF general president Edward Kelly said that “the very gear designed to protect firefighters, to keep us safe, is killing us. Standard 1971 needlessly requires the use of PFAS in firefighter gear.” Standard 1971 refers to a regulation that requires certain components of gear to pass the Ultraviolet Light Degradation Test, which entails gear being exposed to UV light for forty hours without degradation. The only substance that can pass that test is PFAS, but the IAFF believes that it’s an unnecessary standard. While certain states like Massachusetts and Connecticut have taken steps to ban PFAS in turnout gear, there’s still no federal standard banning them, so the IAFF and its various locals are on their own to advocate for themselves.

Bresnan, the Philadelphia local president, hopes that the city will purchase PFAS-free turnout gear. But firefighters are still waiting. “Prior to 9/11, Philadelphia had the most line-of-duty deaths in the country,” Bresnan told Jacobin. “We got cancer presumption legislation [in 2011] at the state level that was one of the biggest bipartisan bills passed. There was only one person who voted against it. It basically says that if a firefighter gets cancer, it’s presumed they got it at work.” The legislation, the Pennsylvania Firefighter Cancer Presumption Act, entitles firefighters with cancer to additional benefits, like larger pensions, lifelong medical benefits, and up to $15,000 to familial survivors to cover funeral costs. Current Philadelphia mayor Cherelle Parker and Pennsylvania governor Josh Shapiro were state representatives at the time, and both voted for the bill.

But according to Bresnan, the city continues to appeal firefighters’ cancer claims. “Like any other legislation, it has all kinds of language that lawyers can use to rack up their billable hours. What is the city paying an outside law firm to fight our members’ cancer claims? I want an audit. I want to see what they are spending in legal fees when they could just approve them. It’s bad enough that the brother or sister has to go home and tell their spouse, ‘Hey, I got cancer, and by the way, not only do we have that fight, we have to fight the city.’ Why give them more stress when they could be losing their life?”

In 2023, the World Health Organization classified the act of firefighting as a Group 1 carcinogen, just like asbestos and tobacco. While firefighters are socially lauded for their vital work, the invisible danger of cancer still looms large. And although there are certainly choices firefighters can make to better protect themselves in the line of duty, cities, counties, and states need to put their money where their mouth is and purchase gear without forever chemicals. Collective bargaining isn’t just economic, it’s life or death — and for as much as firefighters do for us, this is the least we can do for them.