Firefighters Face Alarming Occupational Risk from Carcinogen Exposure

Firefighters face hidden risks from cancer-causing PFAS chemicals in their protective gear, prompting urgent calls for safer alternatives.

• By Johnathan Sharp
• May 13, 2025

Our nation’s first responders put their lives on the line daily to save others. However, firefighters' most dangerous occupational hazards are not blazing flames but carcinogenic chemicals, such as per- and polyfluoroalkyl substances (PFAS). Firefighters' protective clothing, called turnout gear, meant to repel water and protect them from burns and contaminants, is loaded with PFAS. This neglected topic is gaining more attention with the introduction of the PFAS Alternatives Act in July 2023, which aims to facilitate the switch to PFAS-free gear.

PFAS are synthetic chemicals used in many household and industrial products since the 1950s, such as Teflon, Goretex, food packaging, fluorinated firefighting foam, and firefighting gear. PFOA and PFOS, the most common types of PFAS, were classified as human carcinogenic as early as 2014 and linked to kidney, testicular, breast, ovarian, prostate, and thyroid cancers. Furthermore, medical studies show that PFAS exposure causes decreased fertility, weakened immune systems, changes in liver enzymes, and increases in cholesterol levels.

PFAS leaks into the environment, especially our water sources, from the products that contain the chemicals. Unfortunately, PFAS are so resistant that it may take hundreds of years to break down naturally. Thus, these so-called "forever chemicals" remain in the ecosystem and accumulate in our bodies. They have been detected in the blood of 97% of Americans. Amid growing concerns about the nationwide contamination of our water sources with the carcinogenic PFAS, in April 2024, the Environmental Protection Agency set an unexpectedly strict 4 parts per trillion (ppt) national limit for PFOS and PFOA in drinking water. The new regulation signals how dangerous PFAS is, that even the slightest exposure and contamination level is unsafe. 

The problem of cancer-causing turnout gear is finally addressed

Aqueous film-forming foam (AFFF), a highly effective class-B fire suppressant used by civilian and military firefighters since 1967 against flammable liquid fires, was identified as one of the primary sources of PFAS pollution and an occupational hazard for firefighters. Amid increasing concerns about the risks AFFF poses to the environment, firefighter’s health, and the general population, the Department of Defense is now taking measures to replace it with PFAS-free alternatives. On the other hand, the fact that firefighters have been wearing protective equipment containing PFAS has been generally overlooked by Federal and state policymakers.

The International Association of Firefighters (IAFF) has been lobbying for years, urging local fire departments and citizens to call for PFAS-free equipment to reduce cancer risk. Their fight led to the Association filing a suit against the National Fire Protection Associationfor imposing a turnout gear testing standard that requires PFAS. Several states and fire departments have heard their call. For example, in 2024, Connecticut joined Massachusetts and San Francisco City as the first US states to pass laws prohibiting PFAS in firefighters' protective gear. Most fire departments do not have the financial means to test safer options and replace their entire equipment, which is a complex and lengthy process. However, there would be a solution.

The bipartisan legislation Protecting Firefighters and Advancing State-of-the-Art Alternatives Act (PFAS Alternatives ACT) introduced in July 2023 by Congressman Brian Fitzpatrick would authorize $25 million annually for four years for research to develop PFAS-free turnout gear. The Bill proposes an additional $2 million annually for guidance and training on wearing, cleaning, and caring for the next-generation turnout gear. Firefighters across the country have welcomed the Act. It gives them hope that the problem of PFAS in their protective gear, this long-neglected matter of life and death, is finally addressed. 

Science backs firefighter’s concerns

Manufacturers have been silent about the risks wearing turnout gear might pose. The facts slowly started to surface thanks to toxicology studies. A study published in 2020 raised awareness about the presence of PFAS in the three layers of firefighting turnout gear. The research team detected high fluorine concentrations on the two outer layers, the moisture barrier and the outer shell. The researchers found that PFAS can also contaminate the thermal liner in contact with the skin. A more recent study conducted in 2023 reinforced the previous findings. The researchers examined 20 textiles used in turnout and identified 26 PFAS types. The least PFAS was found in the thermal lining, while the moisture barrier and the outer shell had PFAS concentrations up to 400 times higher. The results suggested that with the use of non-PFAS-based water repellent, this unnecessary professional hazard could be eliminated. The scientists emphasized that more research is needed to find an optimal, fluorine-free replacement gear.

The years-long exposure of firefighters to PFAS has devastating consequences. Based on data from the National Institute for Occupational Health and Safety (NIOSH), the Firefighter Cancer Support Network reported that firefighters have a 9 % higher risk of having cancer than the average American. Cancer is a leading cause of firefighter deaths in the US, partly because of the comparatively high levels of carcinogenic chemicals in firefighters’ bodies. 
In 2023, the IAFF reported that 72 percent of deaths among firefighters are caused by cancer, while retired firefighters also face above-average cancer diagnosis, as PFAS lurks in the body for years before the cancer shows symptoms.

Cancer diagnoses among firefighters will continue to rise while they wear toxic “protective” gear. There is a great need for an overarching federal program and fund that invests in research for developing PFAS-free turnout gear and supports firefighters' rigorous training on protecting themselves from the dangerous "forever chemicals." Identifying safe and effective new technology material takes time, research, and testing. The PFAS Alternatives Act could speed up the development of appropriate equipment to replace the toxic ones now in use across the country. Let us support firefighters in their advocacy for more just laws, like the PFAS Alternatives Act. Occupational cancer should not be part of their job.