Cristina Johnson serves as a veteran advocate for Asbestos Ships, a nonprofit that raises awareness of veterans’ exposure to toxic substances.
Intrinsically, firefighters in Delaware — even those enlisted in the military — confront dangers that most people can readily recognize. Flames, collapsing structures, highway collisions, chemical leaks and many other immediate threats have long defined general perceptions of their profession. Yet what most of the public often overlooks is that the most consequential occupational hazards are far less visible — emerging only after years of service and after repeatedly encountering toxic substances on the job. More troublingly, for countless first responders, the cumulative impact of those exposures has transformed cancer into one of firefighting’s most pressing long-term health concerns. This growing crisis eventually helped spur the creation of the National Firefighter Registry for Cancer — an initiative authorized through the Firefighter Cancer Registry Act of 2018 and administered by the Centers for Disease Control and Prevention. Officially launched in 2023, the registry was established to collect health, work history and exposure information from firefighters in Delaware and across the country — regardless of whether they have ever received a cancer diagnosis — to better comprehend how occupational exposures contribute to cancer risk and ultimately identify strategies that can reduce that burden. However, this effort’s success depends not only on its design but on the participation of fire crews themselves, as such is crucial to sufficiently construct the evidence base that truly portrays the entirety of the crisis.
Delaware firefighters are still at risk of toxic exposure
Some of the greatest health threats endured by over 350 firefighters in Delaware are not always encountered in the heat of emergencies. While burns, strains, slips, trips, falls and other traumatic injuries pose visible dangers, many occupational risks — most notably various types of malignancies — manifest gradually through years of regular contact with harmful chemicals emitted during fires, hazmat incidents and even training exercises. Structure and wildland blazes, in particular, can silently discharge a complex mixture of contaminants — including volatile organic compounds, ultrafine particles, polychlorinated biphenyls, flame retardants and heavy metals — as synthetic components are subjected to extreme temperatures, and modern tools and simulators are utilized. Because of these circumstances, first responders become more susceptible to developing malignancies, which have already caused 66% of the career firefighter line-of-duty fatalities just from 2002-19. Though modern protective equipment has significantly improved safety, it cannot entirely prevent exposure, particularly when personnel face these perils routinely over the course of their careers.
For military firefighters, however, the challenge often extends further. Beyond responding to conventional emergencies, they frequently operate in specialized environments — like shipyards, aircraft hangars, depots, fuel storage buildings, maintenance complexes and other military facilities — that present a considerably broader range of potential pollutants. Naval settings can be especially problematic, as fires involving vessels and related infrastructure may release substantial levels of asbestos fibers, lead, carbon-based compounds, mercury and other dangerous compositions into the surrounding environment. Worse, these concerns are amplified by the extensive use of aqueous film forming foam. Since the early 1960s, this Class B firefighting agent has been indispensable across military installations due to its unparalleled effectiveness in suppressing fuel-based fires. Yet unknown to many, its usual formulations — called per- and polyfluoroalkyl substances (PFAS) — have significantly paved the way for critical health and environmental concerns.
As these synthetic chemicals can only break down slowly, their heavy utilization has allowed them to accumulate in the groundwater of about four military installations in Delaware — to wit, Dover Air Force Base; the Duncan Readiness Center and Army Aviation Support Facility; the Wilmington Airport; and the armory north of Newark. Unfortunately, this legacy of contamination means that exposed service members may now be susceptible to malignancies. In fact, even the state’s Fire Prevention Commission has admitted that personnel whose test results show PFAS blood concentrations of 2-20 nanograms per milliliter may likely face potential adverse effects — including breast cancer. Meanwhile, those who exceed that threshold may confront an elevated risk of suffering health problems such as kidney and testicular cancers.
Advancing cancer research through registry participation
Given the wide range of hazards firefighters encounter throughout their careers, understanding their long-term health consequences requires more than isolated studies; it demands a comprehensive system that can track occupational exposures, as well as health outcomes across this occupational group. This need is precisely what the National Firefighter Registry for Cancer was designed to address. By assembling detailed information from firefighters on an unprecedented scale — including active-duty personnel, veterans, retirees and volunteers — the registry provides researchers a timely opportunity to examine how the profession’s various exposures may influence malignancy risk over time. Besides advancing scientific knowledge, the registry’s findings can likewise inform practical improvements in protective equipment, as well as workplace safety practices and health-monitoring programs aimed at identifying illnesses earlier.
Moreover, for the military sector, a growing body of scientific evidence can empower policymakers to broaden the government’s assistance for personnel exposed to hazardous substances. The Honoring Our Promise to Address Comprehensive Toxics Act has already granted presumptive privilege for more than 20 toxin-related illnesses, thereby easing access to compensation and disability benefits for those affected. Yet, even so, some conditions — specifically those attributed to PFAS — remain excluded from this framework, thus burdening the victims with proof that clearly demonstrates direct causation. With the national registry, lawmakers are better positioned to enhance protections, as well as ensure that these brave individuals receive the support they rightfully deserve.
Nevertheless, it is crucial to recognize that the success of this initiative greatly hinges on the active participation of all firefighters. As of June 17, over 50,800 personnel nationwide — with 150 residents in Delaware — have already enrolled in this database. Though encouraging, that figure represents only a very small fraction of the more than 1 million firefighters serving across the country. Simply put, many have stepped forward, but many more remain uncounted. Closing that gap will require sustained outreach from fire departments, veteran organizations and public agencies alike. If efforts are fully leveraged, firefighters and the institutions that support them will better recognize that strengthening participation is essential to ensuring that the data captures the full scope of occupational risk and informs the protection future generations may depend upon.
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.
