Cancer takes heavy toll on Seattle firefighters

By Kathy Mulady and Casey McNerthney, Seattle Post-Intellingencer, 2008

Dave Jacobs started fighting fires when he was 20. It was the only job he ever wanted. He battled brush fires in California, house fires in Oregon and fires of every kind in more than two decades with the Seattle Fire Department.

Now 57, Jacobs is fighting cancer.

A year ago he was diagnosed with esophageal cancer. There are days when he can barely swallow a few spoons of soup. The disease has progressed to his liver and lymph system.

Cancer is a presumptive disease in firefighters - more than a third of Seattle firefighters hired before 1977 have developed some form of the illness. Under Washington law, seven forms of cancer are assumed to be job related when they are diagnosed in a firefighter.

But there are many other cancers that aren't on the list, forcing men such as Jacobs to prove that their illnesses were job related to get workers' compensation. Seattle firefighters say the city is not doing enough to help screen them for cancers and other health risks. City officials are sympathetic but question the effectiveness and cost of health screenings.

"My heart goes out to the other firefighters who have yet to be diagnosed," Jacobs said. "This job is a killer."

According to the International Association of Firefighters, more union firefighters died of cancer in 2007 than from heart attacks or fire-related injuries combined. Nationally, there were 38 union firefighters died last year from cancer, 16 from heart attacks and 10 from fire-related causes. That trend is continuing in 2008.

It is assumed that if a Washington firefighter who was on the job for 10 years develops prostate cancer before age 50, or brain cancer, bladder or kidney cancer, malignant melanoma or several others, it was in the line of duty.

In this state, three of five active firefighters who died this year were cancer victims. The other two died fighting California wildfires.

Seattle Battalion Chief James Scragg - a survivor of the deadly Pang warehouse fire - died of lung cancer Jan. 17 at age 54. Seattle firefighter Tim Heelan, 43, also died in January after melanoma spread to his lungs and spine.

Marty Hauer, a Kent firefighter who traveled the nation teaching fitness seminars to other firefighters, stunned colleagues when he revealed that he had thymic carcinoma, a rare thymus gland cancer. He died in June at 41. Dozens of others are fighting the disease.

Of 975 firefighters hired in Seattle before 1977, about 350 have been diagnosed with cancer, and 43 of the men were younger than 60 when diagnosed, according to numbers from the Seattle Firefighters Pension Board.

Cancer numbers for younger firefighters are harder to track, but firefighter unions and organizations around the country are starting to track the cases.

"There are many more firefighters that are living with cancer today or are cancer survivors," said Dallas Baker, benefits officer for Seattle Fire Fighters Union, Local 27, "not to mention those that died prior to the inclusion of presumptive benefits."

For the first time this year, Seattle firefighters are getting health and fitness exams specifically designed to detect heart disease and cancers linked to their work. Union leaders say the exams are long overdue - and they are frustrated that there are no plans to continue them.

The city of Seattle has agreed to pay a share - about $200,000 - toward the cost of the assessments. Most of the city's 1,000 firefighters signed up for the checkups, which are now wrapping up. The results will be available by early October.

Seattle Fire Chief Gregory Dean said the results will be considered as the department decides on the next step, including whether to continue the exams.

For 13 years, Seattle has been part of a 10-city health and wellness initiative for firefighters. But during that time the city has balked at spending money for the job-specific checkups. It would cost $500,000 to $800,000 per year to provide the tests, according to union leaders.

The issue is part of contract negotiations under way between the city and the firefighters union.

Other cities that provide the annual assessments say it saves them money in the long run.

"We have a really, really good fitness program that include health and wellness testing on a yearly basis, routinely for every firefighter," said Capt. Rita Reith of the Indianapolis Fire Department.

Indianapolis pays $640 annually for each of the city's 949 firefighters. Union leaders can't persuade Seattle to do the same.

"They don't believe it will save money," said Kenny Stuart, president of Seattle Fire Fighters Union Local 27.

Seattle Deputy Mayor Tim Ceis is skeptical of the value of the assessments and concerned about high startup costs of developing an ongoing program. He isn't sold on the idea that a cancer diagnosis is necessarily linked to the occupation.

"There are studies that do show firefighters have a higher incidence of some diseases, a lot of factors go into that, people should not rush off into judgment," he said. "There are ongoing issues that are being analyzed by the state, and we follow it with great interest as information comes forward from the studies."

Ceis said he appreciates the theory that illnesses caught early and healthier employees could cost the city less in sick leave, have fewer on-the-job injuries and be more productive.

"I think we need to prove it," he said. "We have taken a baby step on this to move ahead with the voluntary health assessments. The next discussion is how do we move toward a full system, and how do you realize the savings."

Jacobs believes that if the health assessments were available, his heart attack five years ago might have been prevented and his cancer would have been found earlier.

New kind of fire

In 2006, a University of Cincinnati study found an increased risk of 10 cancers connected with firefighting, and four others with a significantly increased risk connected to firefighting - testicular cancer, non-Hodgkin's lymphoma, prostate cancer and multiple myeloma. The study that noted the actual risk of cancer might be underestimated because firefighters are typically considered healthier than the general population when they enter their careers.

The researchers, who analyzed information on 110,000 firefighters, suggest the protective equipment they used in the past didn't do a good job protecting them against cancer-causing agents.

"Fire departments need to make sure that they manage the risk they're putting their personnel in," said Billy Goldfeder, an Ohio fire chief who runs a Web site about firefighter deaths and injuries.

Flames and collapsing buildings are obvious dangers, but toxic materials that cause cancer are less visible. Noxious gases, fumes and particles seep into their bodies and cling to their skin.

"Fires today are much different than they were 30 years ago," said Rich Duffy, who oversees health and safety issues for the International Association of Firefighters. "Fires today are very toxic."

Firefighters can breathe chemicals and absorb them through their skin, despite masks, airpacks and other protective gear. Billows of black smoke from melting computers, televisions, plastic lumber, glues and petroleum in homes create poisons that are only beginning to be understood.

New studies show that fires continue to be lethal even after the flames are doused. Firefighters who take off their masks to sort through the smoldering remains are as much at risk as those fighting hot flames.

Even back at the station, firefighters face more dangers, some scientists say: exposure to truck diesel fumes, and particles of anything that has returned on their suits, boots and helmets.

"Our turnout gear will off-gas for a couple of days, you can smell it in the rig, in the apparatus bay," Redmond firefighter Melissa Irish said.

"Don't swallow your snot for three days," is advice veteran firefighters still hand down to new crew members.

Jacobs' dad was a firefighter, and by the time he was 19 Jacobs' mind was made up.

Like other firefighters, in the early years he didn't wear a mask.

Jacobs was stunned when a medical examiner hired by the city reviewed his esophageal cancer diagnosis and decided it wasn't job related. His oncologist, Eric Feldman, disagreed, but the city's decision meant he wasn't eligible for workers' compensation, or certain medical benefits.

Jacobs started poring over 650 records of fires he worked. He documented burning boats, cars, trucks and dry cleaners where he had responded. He was eventually able to make his case that exposure to toxic materials likely triggered the cancer, and the city's workers' compensation unit accepted the claim.

Steve Wood, vice president of the Firefighters Cancer Support Network, said cases that don't trigger workers' compensation are why the number of firefighter deaths listed on the National Fallen Firefighters Memorial is low.

Fighting cancer

Unlike Jacobs, Bellevue fire Lt. John Fox wore a mask all but a handful of days in his 36 years as a firefighter.

A firefighter since his volunteer days in high school, Fox has no family history of cancer. He could run for miles, and for years was in top athletic form. Fox said he always followed safety procedures.

So the day an insurance salesman came to his station offering coverage, saying one in three firefighters will get cancer, Fox turned to his two buddies.

"Which one of you two will it be?" he joked.

Later that year, Fox was diagnosed with renal cell carcinoma.

"It's hard for people to talk about," said Fox, whose cancer was presumptively caused by his job.

His doctor told him in 2003 he had one to five years to live. A urologist, knowing the cancer had spread, said an operation would be too late.

The kidney tumors retreated with trial treatment, and Fox, 51, was able to return to work in December 2004. But less than a year later a cancerous spot appeared on his liver.

Trying to find something that would extend his life, last year Fox turned to an expensive dietary supplement that was recently approved by the Food and Drug Administration. Fox believes it works. His last scan this summer showed his one remaining cancerous spot had shrunk.

Esophageal cancer isn't on Washington state's list of cancers that are presumptive in firefighters. Jacobs' oncologist had another opinion. He was confident that the cancer was related to carcinogens Jacobs was exposed to on the job.

In June, Jacobs attended the Washington State Fire Fighters convention to urge the organization to work to add esophageal to the state list of presumptive cancers.

It's not that easy.

"When something burns, it doesn't just create one chemical, it creates a toxic soup of carcinogens," said Keven Rojecki, legislative liaison at the Washington State Council of Fire Fighters. "There just haven't been enough studies to show what is in a standard house fire. Some of the cancers our members are getting are really rare."

"We don't want to start adding a ton of stuff to the law without scientific fact. We are trying to be more progressive than reactionary."

As for Jacobs, he knows he won't win his battle, but still works on his firefighter physique, maintains his fireman mustache, and plans to vacation in Hawaii in January.

He sits cross-legged on a hospital bed at the Group Health infusion center, tethered to a tangle of needles and tubes for seven hours of chemotherapy. The treatment leaves him feeling ill, "like the combination of having the flu and a hangover after running a marathon," he said.

The hours spent on chemotherapy have given Jacobs time to think about the risks of the work. Part of why he shares his story is to open doors to earlier medical care and better health coverage for firefighters.

"I would never hesitate to save anyone who is in a house," Jacobs said. "But once I know everyone is out, their dogs and cats accounted for, why should a firefighter go into a building to save stuff? Is it really fair to my children and my spouse to put my own life and their future at risk to save stuff?"

Fighting fire, then cancer

More than a third of Seattle firefighters hired before 1977 have developed cancer. Under Washington law seven forms of cancer are assumed to be job related when they are diagnosed in a firefighter, but Seattle firefighters say the city isn't doing enough to help screen them for health risks.

Breakdown of firefighters hired before 1977 with cancer by type of cancer, diagnosed between Jan. 2005 and June 2008:

Skin: 137

Prostate: 99

Bladder: 17

Trachea, bronchus and lung: 17

Plasma and immune system: 10

Lymphoid, blood and bone marrow: 9

Colon: 8

Kidney and urinary organs: 8

Breast, reproductive and urinary system: 7

Lymphoid leukemia: 5

Brain: 5

Other: 25

Firefighters hired before 1977: 975

Firefighters hired before 1977 and diagnosed with cancer: 347

Source: Blue Cross and the Seattle Firefighters Pension Board