Sylvester’s Firefighter Cancer Initiative: Advancing Cancer Prevention for Firefighters
Article Summary
- Sylvester’s Firefighter Cancer Initiative aims to prevent and reduce cancer risk among firefighters and support those who have been diagnosed with the disease.
- Its activities include peer-reviewed, firefighter-driven cancer research, prevention and survivorship curriculums and seminars and policy advocacy.
- In carrying out its mission, Sylvester’s FCI has formed partnerships with federal agencies, fire departments and health care professionals statewide and local, national and international professional firefighting organizations.
Smoke banked down to the floor, with flames surrounding him. There wasn’t much time.
Eric Johnson had a decision to make. He could ensure his mask was lined up properly as he felt a stabbing pain in his eye or tend to the nearby man lying on the floor.
He immediately went for the man, safely getting him out of the inferno. Johnson, president of Hialeah Fire Department Local 1102, still feels the effects of his instantaneous reaction years later.
His eye has a burn scar through it. Bascom Palmer Eye Institute had to remove a metal sliver. The damage is for life and the scar prevents corrective surgery or even wearing contact lenses.
None of that matters to him. The only thing that carries weight is that the man on the floor, who suffered burns and smoke inhalation, survived.
“I’m not a hero,” Johnson said. “It’s what I signed up for.”
Johnson told the story at the 2024 International Fire Service Cancer Symposium, hosted by Sylvester’s Firefighter Cancer Initiative (FCI), a program within Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine. The annual event fosters global collaboration to share knowledge and strategies for reducing cancer risk for firefighters.
Firefighters routinely put their lives on the line to safeguard others from peril, storming into infernos, enduring jarring explosions, dodging airborne shards of metal, brick and wood, crawling through collapsing buildings and struggling with searing heat.
But these acute dangers can be eclipsed by the heightened, long-term cancer risks firefighters face. Researchers, many from Sylvester, have uncovered numerous occupational exposures that render firefighters particularly vulnerable to an array of malignancies.
When buildings and vehicles burn, they release toxic chemicals, including volatile organic compounds, asbestos fibers and dioxins. Firefighters can be put at risk even if they wear protective gear, since these toxic materials can be inhaled or accidentally ingested if their masks are slightly askew or absorbed through the skin if the sleeves on their bunker coats ride up only an inch. Modern fires fueled by synthetic materials produce volumes more carcinogens than wood-fueled fires.
As a result, occupation-acquired cancer has become the leading cause of death among firefighters.
Sylvester’s Cancer Research for Firefighters
In response, Sylvester’s FCI has made it a mission to uncover the causes behind firefighters’ heightened cancer risk and pioneer bold, evidence-based strategies to reduce it.
“Our pledge is to protect those who protect us,” said Alberto Caban-Martinez, Ph.D., D.O., M.P.H., deputy director and investigator at Sylvester’s FCI. “Through groundbreaking research and life-saving education, we’re giving firefighters the tools to fight cancer as fiercely as they battle fires, because their health is our greatest victory.”
His comments were echoed by one of Sylvester’s FCI’s primary partners.
“Sylvester’s FCI is a critical reason firefighters can perform their duties in the safest manner, because they independently identify things without bias or financial interest,” said Danny Whu, M.D., chief medical officer for the International Association of Fire Fighters, who noted that Sylvester’s FCI offers research expertise but also listens to needs. “They are humble enough to say if they don’t know certain aspects of how we do our job. And they don’t just ask and move on. They listen and incorporate our perspective in their research.”
Launched 10 years ago in Miami-Dade County and now recognized as a national model, Sylvester’s FCI works with fire departments in virtually every county in the state.
The organization, which comprises a multidisciplinary team of Sylvester-based researchers and clinicians, has undertaken a range of measures in support of its mission. It stresses firefighter-driven science, with firefighters working alongside investigators to inform research questions so they are meaningful, translate to change and save lives.
“Our ability to deliver excellent care to our active and retired firefighters has been greatly enhanced by Sylvester’s FCI’s research findings and the awareness that they are raising. For example, firefighters coming out of a fire with soot on their faces was once a mark of pride. We now know that soot and the smell on the bunker gear are carcinogenic. How did this happen? Follow the dots back to Sylvester’s FCI,” said John Villa, M.D., medical director for the Palm Beach County Firefighters Wellness Center. “Without Sylvester’s FCI, changes to the cultures that fire departments throughout Florida have been making would not have happened.”
Walt Dix, 12th-district vice president of the International Association of Fire Fighters, confirmed the transformative role Sylvester’s FCI has played in upending firefighter culture.
“Sylvester’s FCI has gotten us to focus on the need to decontaminate. They worked with us on developing decontamination standards and gear-cleaning standards. With Sylvester’s FCI’s help, we have put out a decontamination video, and it opened the eyes of firefighters to see what they’re doing to themselves and their families by taking these carcinogens home and exposing their loved ones. And it’s making an impact, changing behavior before our eyes. There is still a lot of work to do, but Sylvester’s FCI has set us on the right path,” he said.
Solutions for Firefighter Cancer Risks
Sylvester’s FCI takes an all-inclusive, activities-driven approach to tackling firefighter cancer risks. It drives firefighter-proposed, peer-reviewed research and hosts scientific seminars on such critical topics as contaminated equipment, fire-site toxins and the effects of shift-work sleep deprivation on the incidence of cancer.
Prevention and survivorship education is made accessible through in-person, online and social media-based curriculums, with select materials translated into Spanish. Hands-on tools such as videos and live demonstrations teach firefighters effective on-scene and post-fire decontamination practices.
The initiative also pioneers advanced technologies, including silicone-based wristbands and body sensors to monitor exposure to hazardous substances, while also distributing thousands of decontamination kits—complete with buckets, brushes, nozzles and soap—to nearly every fire department in Florida.
Statewide mobile clinics bring cancer screenings, prevention strategies and health assessments directly to fire departments. Annual firefighter cancer surveys and ongoing evaluations of sleep, nutrition and lifestyle ensure a holistic understanding of risk factors. Environmental testing and firefighter gear sampling identify hazardous materials at fire sites and stations, reinforcing safety measures.
With a focus on inclusivity, the initiative also develops targeted curriculums and testing for female firefighters, who make up about 9% of Miami-Dade County’s firefighting workforce.
The program’s advocacy efforts have proved central in major milestones, such as the World Health Organization’s International Agency for Research on Cancer (IARC) recognizing firefighting as a carcinogenic profession and the passage of Florida’s presumptive cancer act, which smooths workplace-injury protocols and provides critical, up-front financial support for firefighters facing cancer-related co-pays and deductibles.
All of this work takes resources. The state of Florida has been highly supportive of the Sylvester’s FCI mission through an annual appropriation passed by the legislature and signed by the governor.
“We’ve been blessed to have that funding because it has allowed us to use a multiprong approach to study cancer in the fire service through the projects we have initiated,” said Dr. Caban-Martinez.
Making the Future Better than Today
One of Sylvester’s FCI’s priorities is anticipating future needs by carrying out research in the early stages of a topic. An example is thyroid cancer, which is elevated in firefighters. An annual health exam on a civilian wouldn’t include a thyroid ultrasound unless symptoms or suspicious blood test results were present. But, based on informal evidence, Sylvester’s FCI investigators have been studying the effectiveness of standard ultrasound on firefighters to detect the disease early. If the research backs up its efficacy, a case can be made for incorporating universal coverage of the test under health insurance plans.
A second example occurred this past summer when Sylvester’s FCI convened academic and professional partners to stage an electric vehicle fire. The aim was to assess residue and toxins in the air, soil and water, as well as those absorbed by firefighters and embedded in their gear. Sylvester’s FCI researchers are conducting investigations on the data. Understanding these hazards will enable more targeted protective measures, which is crucial as more people drive EVs.
Eric Johnson’s Personal Battle
Eric Johnson’s advocacy is as determined as his firefighting. He worked passionately with Sylvester’s FCI to ensure the continuation of the Florida presumptive cancer bill, making phone calls, writing letters, meeting with people and making presentations.
“Firefighters are my brothers and sisters, and this was the least I could do for them,” he said.
While devoting himself to the bill’s passage, he never thought it would apply to him. “It didn’t enter my mind. I was healthy and felt fine. I wanted other firefighters to be screened, but I never had a screening myself. After all, I had overcome being shot while breaking up a mugging, survived a plane crash and recovered from complete anaphylaxis, intubation and all, after being bitten by an extremely rare Australian box jellyfish. I wouldn’t get cancer.”
But Johnson was eventually diagnosed with metastatic colorectal cancer, which he apparently had for at least a decade. Things got much worse, as recounted in his address at the Sylvester’s FCI symposium. Johnson was so sick from chemotherapy that he was constantly nauseous and could barely eat. But after years of treatment, he received word last year from his Sylvester physicians that he was officially in remission.
There’s much more work to do to get evidence-based recommendations into the hands of every fire service in Florida and beyond. Sylvester’s FCI is playing a leading part in that mission. Johnson will be right there alongside, pitching in, making presentations and advocating.
“I am so grateful to Sylvester’s FCI, who I consider the real heroes because they are getting the word out to get screened, to be careful, to take precautions, to decontaminate,” he said. “I don’t want any other firefighter to go through what I went through.”
Sylvester’s FCI will host the International Fire Service Cancer Symposium Feb. 20-21 at the Shalala Student Center in Coral Gables, Fla.
Tags: cancer research, Dr. Alberto Caban-Martinez, Sylvester Comprehensive Cancer Center, Sylvester Firefighter Cancer Initiative