Firefighters respond to a myriad of emergencies that can vary significantly from one call to the next. In a typical shift, these personnel may spring into action for a motor vehicle accident along rural routes, then swiftly transition to a raging structural fire as well as a critical medical event at an industrial or residential site. Nevertheless, each situation may place them in environments where heat, smoke and combustion byproducts are often unavoidable.

But though modern gear has indeed enhanced on-scene safety, it does not fully eliminate contact with hazardous substances released during these incidents. The same risks also impact — and are even intensified for — military firefighters, whose duties usually extend to shipboard fires, airfield operations and training exercises where specialized chemical agents may be involved. Unfortunately, this repeated experience has eventually resulted in elevated cancer susceptibility, with statistics indicating a troubling 9% surge in diagnoses among this workforce.

Heeding this escalating concern, Congress passed the Firefighter Cancer Registry Act of 2018 — directing the Centers for Disease Control and Prevention to establish the National Firefighter Registry for Cancer. By consolidating data on exposure history and long-term health outcomes, this systemic tool aims to understand better how firefighting affects cancer incidence over time.

Yet this goal can only be realized if firefighters themselves willingly partake — ensuring their experiences are represented in a repository that guides future research and policy.

The troubling reality of toxic exposure in industrial and military firefighting

Firefighting across Michigan has always carried inherent dangers, and among the most persistent of these is exposure to toxic contaminants emitted during emergencies. Alarmingly, what was once considered a background risk has taken on greater urgency in recent years, as the nature of fires themselves has also changed. According to research, modern buildings and household contents now contain dozens of chemicals of concern — more than 50 sorts of substances embedded in floors, insulation, furniture, walls, and numerous other components — with some detected at levels far exceeding the recommended safety thresholds. As such, when these materials burn, they do not simply produce smoke. Rather, they release a concentrated mix of volatile organic compounds — including formaldehyde, solvents, and ethylbenzene — as well as plasticizers, flame retardants and particulate matter, all of which can be inhaled, ingested or absorbed through the skin during and after a response.

Similarly, leaks or spills introduce an additional layer of peril, as these catastrophic events can likewise expose responders to synthetic, biological, and radiological substances, which typically come in the form of solid, liquid or gas.

Meanwhile, military firefighters also face an even wider range of hazards because of the environments in which they work and live for a long time. From airfields and training grounds to naval vessels and base facilities, these settings can be crammed with advanced chemical agents that become especially dangerous fires. Shipboard emergencies, for instance, can release a dense combination of fuels, solvents, oils and legacy materials such as asbestos — increasing the likelihood of inhalation and surface contamination in confined spaces. At the same time, routine training and operations have correspondingly relied on tools like the aqueous film-forming foam (AFFF), previously hailed for its effectiveness in battling flammable liquid fires but now under intense scrutiny due to its per- and polyfluoroalkyl substances, or PFAS, compositions. Regrettably, extensive utilization of this device has led to severe contamination of soil and groundwater at more than 700 military bases nationwide — including K.I. Sawyer Air Force Base in Marquette County. With all these overlapping exposures, it is no longer very surprising that firefighters face a high risk of cancer over the course of their service.

At its core, the National Firefighter Registry for Cancer was enforced beginning in 2023 to turn individual service histories into evidence that can enhance how long-term occupational risks are understood and addressed. By aggregating exposure and health data from all types of firefighters throughout the country — including those with military-related assignments — this new repository empowers researchers who are currently in pursuit of unraveling updated disease trends. Over the long term, these findings can likewise support improvements in protective equipment, operational standards and health monitoring practices across fire departments.

Beyond this, the data collected can also play a role in shaping how occupational illnesses are evaluated within federal systems, particularly through the Department of Veterans Affairs. 

Many conditions are already acknowledged under the presumptive provisions of the Honoring Our PACT Act, thereby paving the way for more direct access to benefits. Yet notwithstanding this, others — especially those attributed to PFAS exposure — still require stronger documentation of service-related risk before similar recognition can be extended.

At this point, the National Firefighter Registry becomes a key tool for building the long-term scientific evidence needed to clarify relevant health problems and even support future policy decisions. However, apparently, these outcomes depend entirely on firefighters’ determination to take part.

Updates on April 22 show enrollment in the national registry has already surpassed 47,800 participants, with more than a thousand of them residing in Michigan. Even so, these figures account for only a modest fraction of the country’s fire service, which comprises more than a million firefighters.

Closing that gap will require more consistent outreach from fire departments, training programs and veteran support services to ensure the registry is routinely introduced as part of standard professional and transition processes. Firefighters can also be reassured that enrollment is straightforward and can be simply completed with basic service and exposure information through a secure online system. Ultimately, broader participation is what will determine whether the registry can fully capture the scope of occupational risk and translate that evidence into meaningful protection for those still in service.

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Cristina Johnson serves as a veteran advocate at the Asbestos Ships organization, a nonprofit that raises awareness of veterans’ exposure to toxic substances.