Author(s): Jesse Roman. Published on May 1, 2017.

Facing Cancer

As the nation’s fire service acknowledges the toll the disease is taking on its ranks, Boston emerges as a leader in establishing practices to protect firefighters against cancer

BY JESSE ROMAN

On a sunny New England afternoon last July, Boston firefighter Glenn Preston (pictured above) and his eight-year-old son, Jake, cracked jokes in the car on the way to Fenway Park for their annual father-son Red Sox game. As they pulled onto the highway, Preston’s phone started buzzing. The unfamiliar number on the caller ID made him brace for bad news.

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Two days before, doctors at Dana Farber Medical Center in Boston had biopsied a grapefruit-sized growth in Preston’s chest. Not wanting to worry his family, he hadn’t told his wife or his four young children about the procedure. For weeks he had done his best to hide his shallow breathing and near constant exhaustion. He hadn’t mentioned the chest pains or how sometimes when he sneezed it felt like a harpoon had been shot through his chest, dropping him to his knees.

NFPA Conference Session
NFPA Conference & Expo, Boston, June 4-7, 2017

Important Tools in the Fight Against Firefighter Cancer Risk: Fire Station Design and Procedural Changes
Sunday, June 4, 8:30–9:30 a.m.

Paul Erickson, LeMay Erickson Willcox Architects


Firefighter Fatalities and Injuries: Understanding the Problem
Monday, June 5, 9:30–10:30 a.m.

Rita Fahey, NFPA


Every Firefighter Needs an Annual Physical: An Interactive Discussion on Why and How to Make it Happen
Tuesday, June 6, 8–9 a.m.

David Fischler, Suffolk County (NY) Fire Rescue; John Sullivan, Worcester Fire Department


Promoting a Culture of Safety and Fitness: Preventing Cancer, Heart Disease, and Injuries in Boston Firefighters
Tuesday, June 6, 9:30–10:30 a.m.

Michael Hamrock, St. Elizabeth's Medical Center


Cancer in the Fire Service: A Public Policy Risk Analysis
Tuesday, June 6, 11 a.m.–12:30 p.m.

Peter Berger, Hallandale Beach Fire Rescue; Greg Moulin, DFW Airport Fire Department


Related Fire Service Events at C+E

Fire Service App Education Session, "The NFPA First Responder Mobile Portal: Protecting and Empowering First Responders"
Sunday, June 4, 10–11 a.m.

NFPA's Nathaniel Lin and Ken Willette will present an overview of the new NFPA fire service app, designed to provide NFPA information and resources to firefighters. The app is also intended to supply the fire service with relevant news; information on continuing education and certification programs; tools to document and store first responders' well-being and hazard-exposure information; and more.


Fire Service App Announcement
Sunday, June 4, 1 p.m.

As part of his General Session opening remarks, NFPA President Jim Pauley will introduce a new app developed by NFPA to provide the fire service with a variety of critical easy-to-access resources.


First Responder Health Forum
Tuesday, June 6, 9 a.m.–6:30 p.m.

This daylong special event includes expert speakers, networking, health screenings, and tech demos, with topics including cardiac risks, cancer prevention, fitness requirements, occupational health, safety policies, and more. Event includes remarks by Joseph Finn, Boston Fire Commissioner, and Kevin D. Quinn, chairman of the National Volunteer Fire Council.


Coming Up

Fire Service Occupational Cancer Symposium
September 7–8; Sheraton Grand Phoenix Hotel, Phoenix, Arizona

For information, visit the National Fallen Firefighters Foundation online.

He answered his phone. The doctor on the line told Preston he had cancer, that it was advanced, and that he needed to come to the hospital immediately. “Good, good. OK, well, I’m on my way to Fenway now, so maybe we’ll catch up later,” he said, playing it so Jake would think he was talking to an old buddy. Although the doctor strongly advised against it, Preston kept the car pointed toward the stadium. He and Jake stayed for the entire game, and went out for pizza afterward.

A couple of days later, Preston checked himself into the hospital. Doctors told him he had advanced non-Hodgkin’s lymphoma, but he didn’t want to discuss his chances for survival; he didn’t want to know. As thoughts of his kids flashed through his mind, he was indignant but not surprised.

“Since 2000 I’ve been in a really busy company, going to fires and coming out of buildings covered in black, looking like crap,” Preston told me recently. “I thought I’d get cancer—that’s the job. I just didn’t think it would be now.”

With his diagnosis, Preston joins a growing list of sick Boston firefighters, poisoned over their careers by a toxic soup of carcinogenic chemicals absorbed through their lungs, eyes, nose, and skin. On average, a Boston firefighter is diagnosed with cancer every three weeks, according to the Boston Fire Department’s internal figures. Over the last few decades, the age of diagnosis has steadily dropped from the 60s to the 50s, and now, increasingly to the 40s. Preston was 39 when he was diagnosed.

This same reality is playing out in fire departments across the country. Firefighters are dying at alarming rates from an array of cancers, including colon, lung, melanoma, mesothelioma, prostate, rectal, stomach, non-Hodgkin’s lymphoma, and more, which have all been shown in studies to target firefighters in higher numbers than the rest of the population.

While it’s hard to pin down exact figures, the disease is taking a serious toll on the fire service. Sixty-one percent of firefighter line-of-duty deaths from 2002 to 2016 were cancer-related, according to the International Association of Firefighters (IAFF), which obtains its figures from local union reports. That amounts to 1,053 firefighters who have died over that span. Since there is no definitive registry, that figure is almost surely only a fraction of the total.

The lack of reliable data on firefighter cancer deaths illustrates just how overlooked the issue has been. For decades, cancer in the fire service has been discussed in murmurs and whispers, seen by many as the price for doing a dangerous but necessary job. But as the death toll rises and research reveals more about the extent of the problem and its causes, muted concern has given way to a full-scale awakening and mobilization.

“We have a full-court press going on, making sure we do what we can to protect our members—they aren’t always thinking about this, they’re just doing their jobs, but we need to make sure there is awareness and training,” said Pat Morrison, the assistant to the general president for health, safety, and medicine at the IAFF.

There is no more time to waste, Morrison said. “The reality is that cancer is now the leading cause of death for our members, and probably the most important issue we are working on today,” he said. “It’s an epidemic. The trend keeps climbing and climbing.”

Nowhere has the effort to combat cancer been more aggressive—and, in some ways, more unlikely—than in Boston, where the leader of the charge has been Fire Commissioner Joseph Finn.

Finn, a 56-year old mustached former Marine with steely blue eyes, is affable and at times chummy, with an accent and wit to match his working-class Boston upbringing. Though his personality can be disarming, it does little to mask a fiery determination simmering just below the surface, which suggests that Finn is not a man you’d want to disappoint. He has moved up through the ranks over 32 years with the department, becoming commissioner when Boston Mayor Marty Walsh was elected in 2014. Finn believes he has a moral obligation to stem the surge of cancer among his 1,500 firefighters, and since assuming the top job it’s been a full-on assault.

“Firefighting is a family sport, and everybody is tired of watching our family, the members of this department, get sick,” Finn told me in his office over a cup of coffee one snowy morning in early March. He counts nearly 200 friends and colleagues among the dead.

Aided by millions of dollars in financial backing from the city and dedicated labor support from union president Rich Paris, in just two years the Boston Fire Department has gone from barely recognizing cancer as a problem to being viewed as one of the most progressive national leaders in firefighter health and wellness. Finn is now in demand as a speaker at national fire service conferences, and in April he was named the Metropolitan Fire Chiefs Association's Fire Chief of the Year for his part in transforming the Boston department's health and safety culture. He is slated to deliver a talk on firefighter cancer on June 6 at the 2017 NFPA Conference & Expo in Boston, part of the event’s daylong First Responder Health Forum.

Under Finn, Boston’s approach to reducing cancer deaths has been multifaceted, but all means to the same end: limiting a firefighter’s exposure to cancer-causing chemicals. “We drill into every firefighter’s head, ‘take no smoke,’” Finn told me. “Think of smoke as being radioactive—every time you take it in needlessly you are shortening your life.”

Joe Finn and Richie Paris stand outside a Boston firehouse

Bullish on cancer Boston Fire Commissioner Joseph Finn, right, and Rich Paris, president of the city's firefighters' union, are finding ways to work together to combat the department's cancer problem. Photograph: Jesse Burke

Unlike other line-of-duty deaths that play out in one tragic instant, cancer is often a slow killer that blooms only after years of exposure to carcinogens. But it appears that the latency period is shortening, in part because firefighters are being exposed to more carcinogens today than ever before.

Fifty years ago, most of what burned in the typical structure fire included cotton, wood, and other natural fabrics and materials—the products of combustion were not ideal to breathe in, but they weren’t much worse than a campfire, Finn said. Today, almost every structure fire is more like a HAZMAT event—a lot of material is burning and nobody can be sure what toxins may be spewing out.

The contents of modern homes are a hodgepodge of plastics, rubber, and electronics, as well as wood, furniture, and fabrics laced with flame-retardant chemicals. When these materials burn, the products of combustion include a variety of fierce-sounding substances—acrylonitrile, arsenic, benzene, polycyclic hydrocarbons, cadmium, chlorophenols, chromium, carbon monoxide, dioxins, ethylene oxide, formaldehyde, orthotoluide, polychlorinated biphenyls, and vinyl chloride, to name just a few—that have been proven or are widely believed to cause cancer. The chemicals seep into the human body through the nose, ears, lungs, and unprotected skin. They attach like Velcro to anything they touch, such as turnout gear, gloves, hoses, and helmets, which can off-gas dangerous fumes for days, weeks, and months following a fire. The soiled gear contaminates the inside of trucks, kitchens, lockers, and bunks. Recent studies that have analyzed the contents of used vacuum cleaner bags from firehouses in California found numerous dangerous flame retardant chemicals spread out across the living quarters. In some firehouses, it’s not uncommon to see oil slicks resting atop the pool of water in the ice machine following a power outage.

With contamination everywhere, the challenge of protecting firefighters from the deadly onslaught of chemicals is immense, and four years ago it would have been hard to find anyone who would have thought that Boston would be the department to take on such a difficult task.

Fire Service Cancer Stats

For years, Boston Fire had a well-deserved national reputation for being stubborn, old-school, and needlessly resistant to change, often to the detriment of its members. In many companies, wearing self-contained breathing apparatus (SCBA) was optional or even seen as a sign of weakness. Leadership didn’t seem to value personal protection, and the machismo prevalent in so many departments, where soot-covered smoke-eaters were regarded as the bravest and baddest of all firefighters, was rampant in Boston firehouses.

“Plenty of times when I was doing overhaul (after a fire), I’d see guys inside without masks puking out the window from the smoke,” said Lt. Marty Fernandes, 55, who told me he’s seen several firefighter friends die of cancer. “I always had my mask on because breathing that smoke didn’t make me feel good. But I’d hear, ‘Hey, what are you wearing your mask for?’ There’s definitely peer pressure.”

“I only wore my mask when I thought I needed to,” Preston told me. “I’d wait until I thought I couldn’t stand to take anymore smoke, until I was coughing, choking, and spitting. That’s just how we did it. I wanted to conserve air in case I needed it later, or found a victim inside that needed it.”

Firefighters also said that turnout gear was almost never washed because each person only had one good set and the contractor hired to do the cleaning took weeks to get it back, leaving firefighters with a choice between dirty gear or none at all. Filthy coats were known to kick up black dust clouds that enveloped the firehouse, Preston told me. He once resorted to washing his soot-caked turnout coat at a local laundromat. He stuck it in a machine and left, and when he came back to grab it the entire place smelled like it was on fire.

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At the root of many of these problems were adversarial relationships between Boston firefighters, fire department management, and City Hall. Feuding over funding, along with a lack of trust, created widespread dysfunction. Equipment and apparatus were aged and in a state of disrepair; brakes on firetrucks would fail and remain broken for months. Investments over the years in departmental infrastructure were few. Remarkably, the typical Boston firehouse is now 76 years old. With the department just trying to survive, cancer wasn’t on the priority list.

“It’s like in sports, you don’t win a game on just offense or defense—you need both sides of the team to win that game,” Rich Paris, the union president, told me. “We needed management and the union working together to accomplish this. But that wasn’t happening.”

When Finn and Walsh came aboard in 2014, the infighting eased. Finn, himself a former member of the union executive team, met with Paris, and they agreed to work together to devote as much time and as many resources as necessary to combat the cancer scourge. Both men were worn out from watching friends die and families suffer, Paris told me. Both felt that the time for action was long overdue.

“Seeing firefighters in the hospital next to their families and they know they aren’t coming home, or hearing my friends, these big tough firemen, cry and tell me they’re scared—it’s hard,” Paris said. “When I tell them, ‘you’ll be alright,’ I feel like I’m lying to them. There have been times when I’ve said, ‘I’ll see you tomorrow,’ and they die that night. I wish I could show what that’s like to the rest of the department. There are no words to describe what that’s like.”

Industrial cleaning machine in firehouse

Culture of Clean Private donations have helped fund the installation of industrial cleaning machines and drying racks in nearly all of the city's 34 firehouses so that potentially deadly contaminants can be immediately removed from turnout gear. Photograph: Doug Sternberg

In Boston, the fire department has taken a holistic approach to the cancer battle, trying to limit its members’ exposure in a variety of ways. “There is no silver bullet—it is a cumulative effect over a number of best practices,” Finn told me. To reduce exposure from dirty equipment, each Boston firefighter has been outfitted with two pairs of new turnout gear to ensure they always have a clean one at the start of every shift. With the help of private donations, industrial cleaning machines and drying racks have been installed in nearly all of the city’s 34 firehouses so the deadly soot can be washed out as it’s brought back. The city is spending millions for each firehouse to be industrially cleaned, removing decades of soot, diesel exhaust residue, benzene, and a host of other contaminants from the floors, ceilings, walls, and carpets. New firehouses are planned, and others are being renovated to better separate bays from living quarters.

To limit exposure on the fireground, the city has spent $4.5 million to equip all of Boston’s 1,500 firefighters with new SCBA air tanks that hold 45 minutes of air, a 50 percent increase, so they’ll be less likely to remove their masks to conserve air. Protective hoods worn under the helmet and mask to cover the face and neck, once unheard of in Boston, are now mandatory. In addition, 23 new fire trucks equipped with 30-gallon foam bladders have been purchased, so that crews can safely put out car and dumpster fires from a safe distance with foam to limit their exposure to deadly smoke.

Side profile of a firefighter in turnout gear showing how protective hoods are worn under the helmet and mask to cover the face and neck.

Covering Up Protective hoods worn under the helmet and mask to cover the face and neck are now mandatory for Boston firefighters. Photograph: Jesse Burke

Fireground tactics have also been changed so that crews cycle in and out more, limiting each firefighter’s potential exposure. Incident commanders now monitor air conditions, and it’s common to hear over the radio the particulate count and instructions for all firefighters to keep their masks on. A firefighter without a hood or mask is no longer treated like a hero, and there are consequences for not following orders to remain on air.

“Everybody around here is wearing a mask and a hood now, and it’s our job to make sure of it,” Fernandes told me. “If someone sees me not wearing my hood, I’ll never hear the end of it. Joe Finn doesn’t mess around.”

Finn is quick to note that all the best equipment and standard operating procedures in the world won’t mean a thing without buy-in from the rank and file, and the cultural changes needed to achieve it have required the most effort and persistence.

One of Finn’s first moves as commissioner was to create a Safety, Health and Wellness Division within the fire department, which has formulated a strategy directed at the cancer effort. One of the first tasks the division undertook was to hire a production team to create a video featuring Boston firefighter cancer victims, tearful widows and families, and moving images of the hundreds of firefighters Boston has lost.

The idea of the video, released in early 2015, was to “scare the bejesus out of people, and awaken them to the idea that this is no joke,” Finn told me. “No matter how much you try to authoritatively push issues down, the cancer issue comes down to personal responsibility more than anything else. If you go into a burning building and think it’s cool to be the dirty sooty guy coming out, you have to think, ‘what am I doing to my family? What am I doing to myself and the people who are being left behind when I die?’ That is the message we need to keep harping on.”


Watch a video created by the Boston Fire Department on the impact of firefighter cancer.

Sometimes the reality speaks for itself. Since the debut of the video, at least one of the stricken firefighters interviewed, Mark Matthews, has died, leaving behind a wife and two children. When Finn visited him in the hospital two days before his death, Matthews asked his wife to leave the room. He took Finn’s hand and told him, “Don’t let my death be in vain.”

Like all the cancer victims interviewed in the video, and so many other older firefighters in Boston, Matthews believed passionately in the new direction of the department. While several firefighters told me there was still some reluctance in the ranks to change, Finn told me there has been virtually no pushback from the department’s veteran members.

“It has been just the opposite—they understand. They know what we’re talking about. They’ve buried way too many friends, and they’ve seen the human suffering of the children and the widows,” Finn told me. “The challenge is the younger generation—they want to prove themselves and act like they’ve been here since 1965. It’s up to the company officers to step up and make sure the younger firefighters are following best practices. By being leaders and doing their jobs they’re going to save these kids’ lives.”

Glenn Preston didn’t have anyone in his ear telling him about the dangers of smoke when he joined the Boston ranks as a 23-year-old rookie back in 2000. Nobody during his training at the Massachusetts Fire Academy so much as even mentioned the word cancer, he said.

Glenn Preston with son Jake at a Red Sox game.

Brave Face Glenn Preston, with son Jake, on the day last July when doctors informed him he had advanced stage cancer. Photograph: Glenn Preston

As a result, Preston doesn’t get out to his old firehouse in South Boston much these days. For months, his schedule has been consumed by a cycle of weeklong chemotherapy sessions in the hospital, followed by two weeks of recovery at home in Danvers, Massachusetts. But he was recently back in a fire station with his old gear, and a smile on his face, kindly stopping by with his five-year-old daughter, Grace, for a photo shoot and to talk about his cancer with me.

After the shoot, still wearing his bunker gear, he was polite but noticeably fatigued. He needed water, he told me, and instinctively started for the kitchen. Then he abruptly stopped. “I can’t wear this stuff in there,” he said to himself, even though his coat and pants were clean and hadn’t been used in months. A friend grabbed a glass of water for him.

Later, Rich Paris stopped me in the kitchen. “That right there is what’s different in the Boston Fire Department,” he said, nodding toward Preston. “A couple of years ago there’d be six guys lounging around this kitchen with dirty gear and helmets laying everywhere.” Now, the guy who just a year ago wouldn’t use air at a fire until he was choking on smoke won’t even wear his clean turnout gear into a firehouse kitchen.

When I asked him if his cancer diagnosis makes him resent the department or regret becoming a firefighter, Preston quickly answered no. His fire officers didn’t know any better, he said. He didn’t know any better, either. In his mind, it’s nobody’s fault. But now, as he wheezes and looks exhausted after an hour of light activity, he does know better. That’s why he made the 40-minute trek from his home to come and talk to me, he said. He wants other firefighters to know, too.

“I’ve been lucky to have this job,” he said, as Grace crawled on his lap. “These people have been there for me. Maybe I can do something for them.”

JESSE ROMAN is associate editor for NFPA Journal. Top Photograph: Jesse Burke