This story is from The Pulse, a weekly health and science podcast.

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Linda Long spent roughly two decades working as an EMT and paramedic. Then, in her late 30s, she took a pay cut to go after her dream: becoming a firefighter for the city of Philadelphia. 

Long really enjoyed the hard work of fighting fires. She found them “fun, hot, messy.”

“You’re using your body and you wake up and you’re like, ‘Ah, that felt good’,” she said.

Long worked her way up the ranks of the Philadelphia Fire Department, eventually becoming its first female battalion chief in 2017. She still keeps a plaque and an old, stained helmet in her basement, to commemorate the years she served as captain of a ladder unit. 

Long says she responded to hundreds of fires over her career. About half were in homes, but there were other kinds — like trash and garage fires. 

One fire stands out in her memory. On June 21, 2019, an ominous call came over the dispatch radio early in the morning.

A fire had broken out at the massive Philadelphia Energy Solutions oil refinery complex in South Philadelphia. It was a jungle of buildings, pipes and tanks — some filled with flammable fuels and toxic chemicals. Long’s battalion was one of the first called to the scene. 

“As we got dispatched, I was like, ‘Oh, this is gonna be really bad’,” she said.

Soon after firefighters arrived there was a series of explosions, one sending part of a tank the size of a bus flying through the air. 

The fire burned for hours. Hundreds of tons of hydrocarbons were released, as well as more than 3,000 pounds of dangerous hydrogen fluoride, which can damage lung tissue when it’s inhaled. 

“We were at the front step,” Long remembered. “The chemical that came out, I got exposed to that. A lot of firefighters did.”

After the fire, Long says she had trouble breathing for roughly a year. 

“My throat got tight,” she said. “My lungs got tight.”

Then, Long started having different symptoms. 

“I just started feeling dizzy,” she said. “I went to treatment for the dizziness. … I just kept going to different doctors because I’m like, something’s wrong.”

Finally, Long went to see an ear, nose, and throat doctor. She told him how her dizziness would come and go.  

“He just looked at me and he was like, ‘You know what, let’s just check your brain’,” she said. “He took me in for an MRI, and boom.”

Long was diagnosed with glioblastoma, a brain cancer, in 2021. Two years later, she had to retire from the job she loved. 

Long doesn’t think any one incident, like the refinery fire, caused her cancer. But she does blame her decades of exposure to hazardous materials and fumes that came with working as a paramedic and firefighter. 

Cancer risks firefighters face

Lots of factors contribute to people’s risk for developing cancer: genes, lifestyle or the environment they live in. But scientists are learning more about the specific risks that firefighters face.  

A decade ago, a major study by the National Institute for Occupational Safety and Health of nearly 30,000 U.S. firefighters, who worked between 1950 and 2009, found they were diagnosed with cancer at a rate 9% higher than the general population and died from cancer at a rate 14% higher.  

Then in 2023, the International Agency for Research on Cancer (IARC) within the World Health Organization made a striking determination based on dozens of scientific studies. It reclassified the act of firefighting as a Group 1 carcinogen. 

“That’s specifically for mesothelioma and bladder cancer,” said Alberto Caban-Martinez, a professor of public health sciences at the University of Miami who worked on the project. 

In addition to mesothelioma — the cancer caused by asbestos — and bladder cancer, the researchers found emerging evidence that firefighting is also associated with several other types of cancer: colon, prostate, skin melanoma, testis and non-Hodgkin lymphoma. 

For cancers that aren’t on that list, like Long’s brain cancer, scientists say they have not ruled out a connection with firefighting. A couple of studies have found higher rates of brain cancer among firefighters than the general population, while others have not.

“Brain cancer is a much rarer cancer than bladder cancer or prostate cancer, and it makes it really hard to look at,” said Judith Graber, an epidemiologist at the Rutgers School of Public Health who studies the cancer risk volunteer firefighters face. She also contributed to the IARC classification. “That’s why we really need more [research].”

Exposures at work 

Scientists know firefighters face a lot of hazards on the job. 

Burning materials can unleash a soup of toxic chemicals and heavy metals, such as carcinogenic benzene, formaldehyde and cadmium. Collapsed buildings can release dangerous materials like asbestos and silica. Some of the foams firefighters use to put out fires contain PFAS, or “forever chemicals.” Even the trucks they ride in spew diesel exhaust, which is known to cause cancer.

Firefighters can be exposed to these hazards not only during a response, but also afterwards — because toxins can cling to their helmets and gear.  

“There’s a couple of different ways that these different environmental pollutants can enter the firefighter body,” Caban-Martinez said. “If you have any of that dirt or soot on your skin, it’s going to go right inside [you]. The other place is through inhalation.”

Firefighters’ protective gear also contains PFAS to make it water- and oil-repellent. Scientists are still trying to figure out how big of a health risk this poses. 

Night shift work and the stressful nature of the job may also raise firefighters’ risk of cancer, Graber said. Over time, all of these factors and exposures can add up. 

“Cancer is an accumulation of risks,” Graber said. “We’re all born with a plate of cancer risks, and then throughout our lives, it’s increased or perhaps held in check by what we do and what we’re exposed to and what our environments are. Firefighting is going to contribute to that risk. And so for me, when a firefighter gets cancer, that firefighting activity is part of that contribution.”

What firefighters can do to reduce their risk

Brian McQueen used to think dirt and grime were just part of the job when fighting fires — evidence of hard work. 

“We were all that type of firefighter that the dirt on our faces was great, the dirty gear, the dirty hoods,” he said. “For us that was a badge of courage.”

McQueen has been a volunteer with the Whitesboro Fire Department in a small town in Central New York for four decades. He now serves as the department’s safety officer. His wakeup call came 10 years ago, when he was diagnosed with a type of non-Hodgkin lymphoma. 

“It was a total shock to my wife and I, and to my family, that I had cancer,” he said.

McQueen said his doctors told him his illness was likely related to his work as a firefighter. 

After his treatment, McQueen attended a conference with other firefighters where he heard researchers and advocates talk about the health risks of soot and other exposures. 

“We looked at each other and said, ‘What in the world did we do to ourselves, and how can we mitigate that so that the future of our fire service is not going to have to go through those battles?’” McQueen said.

Now, McQueen helps lead a health, safety and training committee with the National Volunteer Fire Council and contributed to a best practices guide for firefighters. 

The guide recommends they wear their protective gear and breathing apparatus the entire time they’re at a fire scene — even after the fire has been extinguished. It recommends they wash contaminants off their clothes and dirty gear, ideally before leaving the fire scene. Then, they should remove and bag their gear before driving away, so it doesn’t gas off inside their vehicle.  

Experts also recommend firefighters “shower within the hour” after responding to a fire. 

“If for whatever reason a shower is inaccessible, especially in the immediate time following a response, just regular cleaning wipes on the skin to wipe off contamination from the fire has been shown to reduce the exposure levels,” said Miriam Siegel, a research epidemiologist at the National Institute for Occupational Safety and Health.

There are also steps that fire department leaders can take to keep their employees or volunteers safe. These include providing firefighters with a second set of gear, getting gear laundered regularly and installing systems to control diesel exhaust inside the fire station. 

Frank Leeb, a retired deputy assistant chief with the New York City Fire Department, says he and others in the department have “moved mountains” in recent years to implement safety programs. He says since 2016, the department has allowed gear to be laundered more frequently, launched an app firefighters can use to request gear laundering, provided gear bags for every firefighter and held free cancer screenings. 

Leeb, who now works as managing director of the First Responder Center for Excellence, says reducing cancer risk throughout the fire service requires a culture shift — including at the top, where leaders need to enforce safety rules. 

“The firefighter is willing to do anything — risk their own life to save the public,” Leeb said. “But oftentimes, they don’t take the steps that are necessary to make sure they’re protecting their own health and safety.”

Linda Long’s fight continues 

Before Linda Long retired from firefighting, she says she tried to push co-workers to take safety precautions, like cleaning and replacing their dirty gear more regularly. She says sometimes this was an uphill battle. 

“So many of us have cancer now,” she said. 

For roughly the last two years, the Philadelphia Fire Department has provided each firefighter with two sets of gear, which are each laundered at least twice a year or anytime a member feels it’s needed, said spokesperson Rachel Cunningham. Since the 2000s, Philly firefighters’ gear has laundered at least once a year, she said. 

Back when Long was diagnosed with brain cancer in 2021, her doctors gave her just six months to live — but she’s far outlived that dire prognosis.   

She’s had two surgeries, chemotherapy and radiation. She wears a special device on her head that sends electric fields into her brain to try to stop tumor growth, powered by a big battery she totes around in a backpack. 

Despite her serious health challenges, Long has been able to do a lot over the past few years. She’s organized friends to participate in 5k walks to raise money for brain cancer research and she’s traveled. 

“I’ve been to Iceland now three times, because I just love Iceland,” she said. 

But a few months ago, before she was set to leave for another trip, she went to her doctor for an MRI. 

“My doctor was like, ‘Linda, there’s something growing’,” she said. “So I had to cancel that trip.”

The cancer was back.  

Long started chemo again. Now, she has a hard time getting around. But she’s hoping next year, she feels well enough to walk in the 5k to raise money for research and to keep raising awareness. 

“Hopefully, next year, I can go again.”