Firefighters in Missouri confront risks posed by cancer

COLUMBIA, Mo. -- When he was 44, Marc Wright had the biannual physical required by the city for Columbia firefighters. He'd just returned from a vacation where he'd completed a three-hour volcano hike and felt great -- in good shape for his age.

Wright's other, routine physicals in the past several decades with the Columbia Fire Department had come back fine -- normal. So he was surprised when the results this time looked different. His hemoglobin was low, and he'd recently been diagnosed with anemia.

The physician suggested Wright get a colonoscopy. He scheduled a procedure not many 40-year-old men are thinking about, though the incidence of colon cancer among men in his age group is increasing.

He was leaving the recovery room after his colonoscopy when a doctor gave him the news: "You have colon cancer."

Just like that, Wright went from an active, volcano-climbing firefighter of 23 years to a person fighting colon cancer. Although it's not possible to prove the cancer was caused by the work, Wright believes the time he spent as a firefighter is at the root of it. His suspicion is understandable: Firefighters have a 14 percent higher risk than the general population of dying from cancer. And more than 60 percent of line-of-duty deaths of firefighters are attributed to cancer.

It's a threat much less obvious than the danger posed by running inside the crumbling walls of a burning building, enduring temperatures as high as 1,000 degrees or navigating when there's little or no visibility in dark, heavy smoke.

There’s no question being a firefighter is dangerous. Columbia has lost two firefighters in the line of duty in the past 30 years: Donald Crum who was killed when the fire truck he was riding on turned over in 1986, and Bruce Britt who was killed in a walkway collapse in 2014.

Two of every three firefighters will be diagnosed with cancer sometime in their lives. Compared to the general public, firefighters face a two-times greater risk for testicular cancer and a one and a half increased risk for multiple myeloma, which is a cancer that begins in white-blood cells.

Columbia fire captain Jeff Strawn was shocked to learn how often firefighters were getting diagnosed with cancer. After two of his former fire-department colleagues -- one of them Wright -- were diagnosed with cancer in the past five years, Strawn did some research. Could there be a link between firefighters and cancer? The more he looked, the more Strawn realized his firefighting friends' recent diagnoses were not isolated incidents.

"It became clear to me that this was an epidemic," Strawn said. "That's what it is, an epidemic within the fire service."

The National Institute for Occupational Safety and Health launched a study of nearly 30,000 firefighters from San Francisco, Chicago and Philadelphia in 2010. The firefighters studied had worked at least one day of active duty between 1950 and 2010. Health conditions, diagnoses and deaths were compared to national and state populations.

When the study concluded in 2015 and the results were analyzed, the results were clear: The firefighters in the study had a higher incidence of cancer diagnoses and cancer-related deaths, particularly respiratory, oral and digestive cancers.

The study also showed compared to the general population, nearly twice as many firefighters had malignant mesothelioma, which is a rare type of cancer caused by exposure to asbestos, a fire-resistant chemical used in domestic and industrial products.

"This study was huge for us," Strawn said. "We knew it, but we needed someone with bigger teeth to say, 'Hey, this is true.'"

Along with the results of NIOSH, a study conducted by the University of Cincinnati in 2006 showed firefighters are twice as likely to develop testicular cancer and have significantly higher rates of non-Hodgkin's lymphoma and prostate cancer as non-firefighters. Although it's unlikely a local or state study of firefighters will be conducted because of a lack of time and funds, Strawn said 12 to 15 of his colleagues in Columbia alone had been diagnosed with cancer, primarily after retirement.

Strawn's research led him to the Firefighter Cancer Support Network, a national organization that works to assist firefighters such as Wright who are diagnosed with cancer. The organization was started in 2005 by Los Angeles County Fire paramedic Michael Dubron, who survived stage 5 colon cancer. Each state has a group of volunteers -- overseen by a director -- who localize the program to departments in their state.

Strawn learned there was no state director for Missouri and saw an opportunity. He launched the Missouri chapter of the Firefighter Cancer Support Network in 2015 and has been the state director ever since.

Although Strawn never has battled cancer, seeing co-workers and friends fall ill after years in fire service sparked a concern within him.

"When it's in front of you, when it gets someone you work with," Strawn said, "that's when it hits home."

Strawn works with two Support Network correspondents in Missouri, one in Kansas City and one who recently signed on in St. Charles, along with other volunteers across the state.

The team's main goal is education. Volunteers travel to fire departments to teach firefighters and their department heads not only about the dangers of smoke inhalation and exposure to toxins, but also how they can reduce the risks before entering a burning structure. The courses emphasize the 11 steps of the immediate action module. The list gives firefighters tips to lessen the risk of cancer.

Ironically, one of those risks is the firefighter's protective gear.

"If you don't wash your gear after every exposure, those materials absorb those carcinogens," Columbia fire chief Randy White said. "We eventually soak them in through our skin and breathe them in because we're carrying them around with us when we wear our gear for other events. It's very important to keep your gear clean."

White has been with the Columbia Fire Department for 19 years, the past two years as fire chief. When he started out as a firefighter, cancer as an occupational hazard wasn't on anyone's radar. The biggest danger was thought to be fighting the fire itself. And the sign of a good firefighter was a smoked-up helmet and dirty bunker gear. Wright recalls getting in the shower after returning from emergency calls, washing off the soot and seeing smoke in his pores.

"The black would just rush off of you all over the place. You'd clean out your nose and stuff, and black nasty stuff would come out," Wright recalled. "It was just part of our daily life. Take a shower and get ready for the next one."

Columbia firefighters are responsible for washing and drying any exposed gear so it's ready for the next shift of officers to wear. Ideally, the gear should be washed in a commercial extractor, which is a high-speed washing machine that performs more than 1,000 rotations per minute and extracts toxins more thoroughly than a regular washing machine.

Although washing through an extractor is ideal, the price is prohibitive; a commercial extractor costs about $1,000.

This makes it difficult for every station in Columbia to have one. Columbia stations 1, 7, 8 and 9 have extractors, and White said the Columbia Fire Department is looking to potentially install extractors in stations 2 and 3, with hopes to put more of the machines in stations 4, 5 and 6 as remodeling occurs.

"Obviously, there's a higher awareness of things that could cause cancer for firefighters, and that's bringing about changes in the entire service as to, OK now we're aware of it so how are we going to address it?" White said.

It's not a quick process, he said.

"It always makes things more difficult when there's money involved."

After Wright's diagnosis two years ago, Strawn was just getting started as the state director for the Missouri chapter of the network. Although Wright didn't know much about the organization, he and Strawn went to high school together and had been friends a long time. So Strawn was quick to reach out to him with support.

Wright went through continuous rounds of chemotherapy and radiation. After his first surgery and six months of chemotherapy, the cancer in Wright's colon was gone. Three weeks later, an MRI scan showed the cancer had moved to two spots on his liver. Those were treated, and a new tumor formed on his liver. The doctor told him without any further treatment, Wright had anywhere from months to two years to live.

Wright pushed through. Anything to beat this, he told the doctors. Throughout his treatment, he continued to work for the Columbia Fire Department for two more years.

"I'd be at work, go back and get radiation, then go back to work," Wright said. "I think being at work through all those treatments kept me mentally strong, and it kept me in a routine instead of being at home on the couch."

As a division chief at the time of his treatment, he wasn't fighting fires. He was able to go to work wearing a chemotherapy pump and leave for treatments when necessary. He retired with full benefits on the typical schedule for a firefighter's career after 25 years in service, two of which he fulfilled while battling cancer.

However, unlike Wright, many firefighters are diagnosed with cancer after they are retired. Compensation and benefits for people who are diagnosed after retirement aren't always as clear-cut for the Columbia Fire Department.

"Cancer from fire service is a multiple exposure over multiple years kind of thing," White said. "If you're still working here when you're diagnosed, we have our health insurance that goes with that. However, folks are retiring. They come back years later with an incident of cancer, and that cause and effect is a little harder to see."

The Columbia Fire Department is working with people such as Strawn to educate their firefighters and improve awareness. The department hosts annual courses conducted by the network to teach about smoke inhalation and overall cancer risk awareness. The fire department also sends out bulletins to each fire station, reminding firefighters how often they should clean their gear. If a firefighter has worked a structure fire where a lot of carcinogenic material has burned, he or she is expected to wash the gear immediately. If he or she hasn't been exposed, the gear should be washed thoroughly every six months. The department also provides the safety information to officers, who are expected to make sure their crew is following the protocol.

Firefighters are urged to shower immediately after a fire, and to keep their gear away from living quarters, for example, on hooks in the bay of the station, or sometimes on or near the fire truck itself. The department also is working toward providing two sets of gear for each firefighter, so one can be washed while the other is in use, he said.

"It's a work in progress, trying to figure out the best ways to help combat this," White said. "Can't not go in the fire, but then again what do we do coming out to reduce our risk?"

Wright believes the job is just as dangerous as it was 20 years ago. He thinks it's important the knowledge and technology available today be used to prevent firefighters from getting cancer 20 years from now.

"We've got to be careful on every call, we've got to wear our gear, we've got to train properly and take the precautions," he said.

After two years of chemotherapy, day-long surgeries, radiation and a whole lot of prayer, Wright's latest MRI scan a month ago came back cancer-free. He's traveling, watching his nephews' sports games and exercising five times a week. Despite his diagnosis and knowing what he knows now about the hidden risks with the job, he said he would do it all over again.

"It's one of my favorite things I've ever done in my life," he said. "It sounds weird, but I was meant to do it. I knew that I was fulfilling my dream. That's what I always wanted to do as a kid, and I was able to do it until I was 46 years old."

Information from: Columbia Missourian, http://www.columbiamissourian.com