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By Yen Duong

When firefighters sign up for the job, they’re aware of the dangers of flames, heat and smoke from burning buildings. But they often don’t know about the slower, lingering dangers that can hurt them even when they’re working in the firehouse.

Firefighters are 14 percent more likely to die from cancer than the average American, according to a National Institute for Occupational Safety and Health study. That’s because in the course of duty, firefighters are exposed to a host of cancer-linked chemicals such as asbestos, formaldehyde and benzene, and they carry those back to the station on their gear.

A poster about preventative habits in the Charlotte Fire Department Headquarters. Photo credit: Yen Duong

A community program from the Levine Cancer Institute in Charlotte is trying to fight that statistic. Code T.O.M., named after a firefighter who died of melanoma in 2013, brings head-and-neck cancer screenings and seminars to fire stations around the state.

Since the program began in May 2016, it has reached over 3000 firefighters in the Carolinas, said Mellisa Wheeler, who runs community outreach for Levine.

“A firefighter who doesn’t smoke will never qualify for the national guidelines for the lung cancer screening,” Wheeler said. “That means insurance would never pay for it, that person would likely have to pay out of it pocket… We are seeing lung cancers in the fire service diagnosed at later stages because they’re not being screened.”

‘Story just repeats itself’

At the end of 2010, firefighter Tom Robinson mentioned a sore spot on the bottom of his foot to his doctor. They agreed that the dot, smaller than a pen nib, was nothing.

By the next year, Tom had hollowed out a hole in his shoes for the growing sore. In January 2012, his son, James Robinson, dragged him back to the doctor’s office, where a biopsy revealed malignant melanoma. By then it was too late—Tom died in March 2013 at the age of 64.

“This story just repeats itself throughout the fire service over and over and over again,” Robinson said. “The fire service is full of Type A people; they go out when everybody else is trying to get away from a situation, and they don’t think anything about it. The fact that they do that on a daily basis makes you wonder, ‘Okay, how often are they checking themselves for all these other things that could be potential exposures?’”

Robinson knows that personally. On top of his full-time job managing the mobile medicine fleet for Atrium Health, he puts in 10 to 20 hours a week as a volunteer fire chief for Chesterfield Fire and Rescue in Burke County, northwest of Charlotte. Robinson took over the job after the previous chief died of colorectal cancer at 46. He knew plenty of firefighters who have or have died of cancer, and he wanted to help.

“Dad’s rule was you can share with anybody that you need to, as long as it helps one family not to have to go through this whole experience,” James Robinson recalled. “That was all that he cared anything about, trying to prevent one other family member from having to experience this horror.”

That’s what the younger Robinson did. At an event unveiling Atrium’s mobile lung cancer screening unit, he told Wheeler about Tom’s story. Code T.O.M., which stands for Taking on Melanoma, was born. Wheeler anticipated educating 400 firefighters by the end of 2016 but ended up reaching over 1,200 due to the popularity and convenience of the program.

“As soon as one station heard about it, we would get another call and another call and another call,” Wheeler said. “A lot of these guys work a 24-hour shift and it’s hard for them to get out of the station. We take screening to the fire station and make it much easier, and then they’re with the rest of their team. It makes it a more comfortable experience.”

Applying the research

Posters about cancer risk are scattered around the Charlotte Fire Department Headquarters, an airy brick-and-glass building just north of Uptown. Captain J.B. Kiser, who works on health and safety, said that the department has had success in changing their culture thanks to Code T.O.M. and other programs. For instance, they now offer cancer screenings and education at the annual retiree fish fry, and they’re on track for every firefighter getting an annual physical in 2019.

The Charlotte fire department is the largest in the state, with about 1100 firefighters. Photo credit: Yen Duong

In 2017, they won a federal grant to pay for a second set of gear for the 1,100-person department, the largest in North Carolina. That helps firefighters minimize their exposure to contaminants because they can wash the gear in between fires.

“In years past, you would come back to the station, and just keep on carrying on,” Kiser said. “Now we’re trying to really push [that] if you go to a fire, when you go back, take your uniform off, shower.”

Dr. Alberto Caban-Martinez, a professor at the University of Miami trying to figure out how and why firefighters get cancer, said that measures such as showering and wiping gear are necessary preventative steps. Caban-Martinez’s current national study uses silicone wristbands to measure the chemicals that firefighters encounter in their lives.

“There’s no reason for you not to decontaminate on-scene,” Caban-Martinez said. “As soon as you have that fire incident response, bring out the bucket and then hose yourself down so you don’t transfer the carcinogens back to your truck, back to your station, even back to your home.”

Dr. Alberto Caban-Martinez, a professor researching how and why firefighters are more likely to get cancer than the average population, speaking at an American Association for Cancer Research session. Photo credit: Yen Duong

Kiser said the Charlotte fire department is now looking into buying new hoods for firefighters with particulate-blocking fabrics, as opposed to the current hoods which help keep heat and flame away from faces but still let in smoke. Caban-Martinez said that’s a good idea.

“Sometimes the plume of smoke can actually enter [the hood] and it can enter the skin,” Caban-Martinez said. “Certain flame retardants that get aerosolized from burning can enter and affect the thyroid… Those chemicals make the thyroid think they’re normal hormones and can cause [cancer].”

‘Risk always exists’

In North Carolina, a bill to support firefighters is making its way through the Senate. H.B. 520, which expands workers’ compensation to cover nine more cancers as occupational hazards, was unanimously passed by the House in May, and has been waiting for action in the Senate. Provisions to benefit firefighters were also included in the compromise budget passed by the legislature and vetoed by Gov. Cooper last Friday. 

Read more: NCHN wrote about H.B. 520 on May 1, but the first time NCHN wrote about a similar bill was in 2016.

In the meantime, Code T.O.M. is operating, sending a team including a physician assistant to perform screenings and hold classes across the state. When Robinson stops by the Code T.O.M. classes, he likes to address fire chiefs, captains, lieutenants and other leaders, he said.

“I challenge those old-time guys, I’m like, ‘Look, you have been exposed, you are at an increased risk for cancer. We know that. But let’s look at the next generation of guys,’” Robinson said. “How do we protect them?

“Risk always exists. But how do we mitigate that? How do we reduce it as much as possible, and get this next generation of firefighters safe and protected?”

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Yen Duong

Yen Duong covers health care in Charlotte and the southern Piedmont for North Carolina Health News.